GERMAN-CAO-ARO-AIO-94

Regimen

Experimental
Preoperative CRT (50.4 Gy + 5-FU infusion) → surgery → adjuvant chemotherapy
Control
Surgery → postoperative CRT (55.8 Gy boost + 5-FU) → adjuvant chemotherapy

Population

Clinical stage T3, T4 or node-positive rectal cancer (N=823); landmark trial establishing preoperative vs postoperative CRT.

Key finding

5-year local recurrence: preoperative CRT 6% vs postoperative CRT 13% (P=0.006); 5-year OS: 76% vs 74% (P=0.80, not significant); acute toxicity grade 3-4: 27% vs 40%; long-term toxicity: 14% vs 24%. Sphincter-preservation rates improved with preoperative CRT. Paradigm shift: preoperative CRT becomes standard.

Source: PMID 15496622

Timeline

    Guideline citations

    • NCCN Colon (p.168)
    • NCCN Rectal (p.60)