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China's answer to the same question as RAPIDO: one week of radiotherapy followed by chemotherapy matched five weeks of chemoradiotherapy, with more short-term toxicity.
STELLAR randomised 599 patients with locally advanced rectal cancer to short-course radiotherapy (25 Gy in five fractions) followed by four cycles of CAPOX and then surgery with two more cycles, or to chemoradiotherapy (50 Gy in 25 fractions with capecitabine) then surgery and six cycles of CAPOX. Three-year disease-free survival was 64.5 against 62.3 percent (hazard ratio 0.883, upper bound of the one-sided 95% CI 1.11, within the non-inferiority margin). Acute grade III to V toxicity during preoperative treatment was 26.5 against 12.6 percent. Overall survival favoured the total neoadjuvant arm (p=0.033). STELLAR and RAPIDO together made short-course radiotherapy followed by consolidation chemotherapy an accepted schedule outside northern Europe.
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.
599 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Disease-free survival at 3 yearsprimary | Short-course radiotherapy then chemotherapy | 302 | 64.5 percent | 0.883 | - | link |
| Long-course chemoradiotherapy | 297 | 62.3 percent |
Shares CAO/ARO/AIO-94 (German Rectal Cancer Study), PRODIGE 23, OPRA, Chemoradiation (chemoradiotherapy, CRT).
Shares RAPIDO, PRODIGE 23, OPRA, Chemoradiation (chemoradiotherapy, CRT).
Shares Stockholm III, CAO/ARO/AIO-94 (German Rectal Cancer Study), RAPIDO, Rectal cancer.
Shares Stockholm III, Rectal cancer, IMRT / IGRT (modern external beam), Colorectal cancer.
Shares RAPIDO, Chemoradiation (chemoradiotherapy, CRT), CAPOX (capecitabine, oxaliplatin), Oxaliplatin.
Shares PRODIGE 23, Chemoradiation (chemoradiotherapy, CRT), Oxaliplatin, Capecitabine.
Shares CAPOX (capecitabine, oxaliplatin), Capecitabine, Rectal cancer, IMRT / IGRT (modern external beam).
Shares Oxaliplatin, Capecitabine, Rectal cancer, IMRT / IGRT (modern external beam).