Total Neoadjuvant Therapy for Locally Advanced High-Risk Rectal Cancer

Chemoradiotherapy followed by surgery and adjuvant chemotherapy is standard treatment for locally advanced rectal cancer. The approach of total neoadjuvant therapy — administering all chemotherapy and radiation therapy prior to surgery — is of increasing interest.

Investigators now report results of the RAPIDO trial, an international, open label, randomized, phase 3 trial that compared conventional therapy with a total neoadjuvant regimen. Eligible patients had clinical high-risk features on pelvic MRI, including T4 or N2 disease or evidence of mesorectal fascial involvement. Patients were randomized to either 1) conventional chemoradiation with oral capecitabine, pelvic radiation with 25 fractions of 2 Gy (50 Gy) or 28 fractions of 1.8 Gy (…