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Colorectal cancer

TNT and local recurrence in the RAPIDO trial — untangling the puzzle

Nature Reviews Clinical Oncology volume 20, pages 357–358 (2023)Cite this article

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Neoadjuvant chemotherapy offers a pragmatic alternative to the difficulties associated with delivering timely adjuvant chemotherapy in rectal cancer. Enthusiasm for administering neoadjuvant therapy to all patients with locally advanced rectal cancer is based on data from several phase III trials. Data from the RAPIDO trial are a critical component of this evidence.

Refers to Dijkstra, E. A. et al. Locoregional failure during and after short-course radiotherapy followed by chemotherapy and surgery compared to long-course chemoradiotherapy and surgery – a five-year follow-up of the RAPIDO trial. Ann. Surg., https://doi.org/10.1097/SLA.0000000000005799 (2023).

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Fig. 1: Fragmentation of locally advanced rectal cancers following an extended delay between radiotherapy and surgery.

References

  1. Bahadoer, R. R. et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open label, phase 3 trial. Lancet Oncol. 22, 29–42 (2021).

    Article  CAS  PubMed  Google Scholar 

  2. Conroy, T. et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 22, 702–715 (2021).

    Article  CAS  PubMed  Google Scholar 

  3. Jin, J. et al. A multicenter, randomized, phase III trial of short-term radiotherapy plus chemotherapy versus long-term chemoradiotherapy in locally advanced rectal cancer (STELLAR): the final reports. J. Clin. Oncol. 40, 1681–1692 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Dijkstra, E. A. et al. Locoregional failure during and after short-course radiotherapy followed by chemotherapy and surgery compared to long-course chemoradiotherapy and surgery – a five-year follow-up of the RAPIDO Trial. Ann. Surg. https://doi.org/10.1097/SLA.0000000000005799 (2023).

    Article  PubMed  Google Scholar 

  5. Ciseł, B. et al. Long-course preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study. Ann. Oncol. 30, 1298–1303 (2019).

    Article  PubMed  Google Scholar 

  6. Liao, C. K. et al. Neoadjuvant short-course radiotherapy followed by consolidation chemotherapy before surgery for treating locally advanced rectal cancer: a systematic review and meta-analysis. Curr Oncol. 29, 3708–3727 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lefevre, J. H. et al. Effect of interval (7 or 11 weeks) between neoadjuvant radiochemotherapy and surgery on complete pathologic response in rectal cancer: a multicenter, randomized, controlled trial (GRECCAR-6). J. Clin. Oncol. 34, 3773–3780 (2016).

    Article  PubMed  Google Scholar 

  8. Erlandsson, J., Pettersson, D., Glimelius, B., Holm, T. & Martling, A. Postoperative complications in relation to overall treatment time in patients with rectal cancer receiving neoadjuvant radiotherapy. Br. J. Surg. 106, 1248–1256 (2019).

    Article  CAS  PubMed  Google Scholar 

  9. Deidda, S. et al. Association of delayed surgery with oncologic long-term outcomes in patients with locally advanced rectal cancer not responding to preoperative chemoradiation. JAMA Surg. 156, 1141–1149 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jankowski, M. et al. Watch-and-wait strategy in rectal cancer: is there a tumour size limit? Results from two pooled prospective studies. Radiother. Oncol. 160, 229–235 (2021).

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Radiotherapy Department, Mount Vernon Centre for Cancer Treatment, Northwood, UK

    Robert Glynne-Jones

  2. Department of Colorectal Surgery, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK

    James Hollingshead

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  1. Robert Glynne-Jones
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  2. James Hollingshead
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Correspondence to Robert Glynne-Jones.

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Competing interests

R.G.-J. has acted as an advisor and/or consultant of Amgen and Incyte and has received honoraria for lectures from Servier and Johnson & Johnson. J.H. declares no competing interests.

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Glynne-Jones, R., Hollingshead, J. TNT and local recurrence in the RAPIDO trial — untangling the puzzle. Nat Rev Clin Oncol 20, 357–358 (2023). https://doi.org/10.1038/s41571-023-00751-4

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