RAPIDO

Regimen

Experimental
Short-course RT 5×5 Gy → 18 weeks CAPOX or FOLFOX4 → TME (TNT consolidation approach)
Control
Long-course CRT (50.4 Gy + capecitabine) → TME → optional adjuvant capecitabine

Population

High-risk locally advanced rectal cancer (MRI-defined: cT4a/b, extramural vascular invasion, cN2, involved mesorectal fascia, or lateral lymph nodes), N=920.

Key finding

3-year disease-related treatment failure: TNT (short-course 5×5 Gy + 18-week CAPOX/FOLFOX) 23.7% vs standard CRT 30.4% (HR 0.75, P=0.019); pCR 28.4% vs 14.3% (P<0.0001); 3-year OS similar (89.1% vs 88.8%). TNT reduces distant failure; OS benefit not yet demonstrated.

Source: PMID 33301740

Timeline

    Guideline citations

    • NCCN Rectal (p.6)