The RAPIDO trial compared short-course preoperative radiotherapy (SCRT) followed by systemic chemotherapy versus standard-of-care chemoradiotherapy followed by TME in locally advanced rectal cancer. Its primary endpoint result demonstrated:

• A SCRT was associated with higher local recurrence rates compared to long-course CRT
• B SCRT plus consolidation chemotherapy significantly reduced the rate of disease-related treatment failure (distant metastasis) compared to standard long-course CRT ✓
• C Both regimens had identical pathological complete response rates
• D Long-course CRT was superior to SCRT in achieving R0 resection

Explanation

The RAPIDO trial (Bahadoer et al., 2021) demonstrated that total neoadjuvant therapy using SCRT (25 Gy/5 fractions) followed by 18 weeks of systemic chemotherapy (FOLFOX4 or CAPOX) before TME significantly reduced 3-year disease-related treatment failure (distant metastasis rate) compared to standard long-course chemoradiotherapy (CRT) followed by TME and adjuvant chemotherapy. SCRT plus consolidation chemotherapy also achieved higher pathological complete response rates (28% vs 14%), supporting total neoadjuvant therapy as a new paradigm for locally advanced rectal cancer.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.