OPRA

Regimen

Experimental
Consolidation TNT: long-course CRT → FOLFOX/CAPOX × 4 months → restage → watch-and-wait or TME
Control
Induction TNT: FOLFOX/CAPOX × 4 months → long-course CRT → restage → watch-and-wait or TME

Population

Stage II–III rectal adenocarcinoma (N=324), candidates for organ preservation; comparing TNT sequence (consolidation vs induction).

Key finding

3-year organ preservation: consolidation TNT 58% vs induction TNT 43% (HR 0.65, P=0.027); cCR rates 38% vs 24% at time of restaging. Consolidation approach (CRT first, then CAPOX/FOLFOX) achieves higher organ preservation than induction approach (chemo first, then CRT). For patients prioritizing organ preservation, consolidation TNT is preferred sequence.

Source: PMID 35483010

Timeline

    Guideline citations

    • NCCN Rectal (p.57)