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RAPIDO showed that giving one week of radiotherapy and then all the chemotherapy before surgery cuts distant spread and doubles complete responses in high-risk rectal cancer, establishing total neoadjuvant therapy.
RAPIDO randomised 920 patients with high-risk rectal cancer on MRI to short-course radiotherapy (25 Gy in five fractions) followed by six cycles of CAPOX or nine of FOLFOX then surgery, or to standard capecitabine chemoradiation, surgery and optional adjuvant chemotherapy. Disease-related treatment failure at three years was 23.7 percent with the experimental approach versus 30.4 percent, driven by fewer distant metastases, and pathological complete response doubled to 28 percent (Bahadoer and colleagues, Lancet Oncology 2020). Later follow-up reported more local regrowth in the experimental arm, tempering enthusiasm for the shortest radiotherapy.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
920 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Disease-related treatment failure at 3 yearsprimary | Total neoadjuvant therapy | 462 | 23.7% | - | - | - |
| Standard chemoradiation | 450 | 30.4% |
Shares International Watch & Wait Database, CAO/ARO/AIO-94 (German Rectal Cancer Study), STELLAR (rectal cancer), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint and the tag radiation-wave4.
Shares IMRT / IGRT (modern external beam) and the tag radiation-wave4.
Shares IMRT / IGRT (modern external beam) and the tag radiation-wave4.
Shares IMRT / IGRT (modern external beam) and the tag radiation-wave4.
Shares IMRT / IGRT (modern external beam) and the tag radiation-wave4.
Shares IMRT / IGRT (modern external beam) and the tag radiation-wave4.
Shares IMRT / IGRT (modern external beam) and the tag radiation-wave4.
Shares IMRT / IGRT (modern external beam) and the tag radiation-wave4.