A Swedish study has shown that total neoadjuvant treatment (TNT) for locally advanced rectal cancer (LARC) is effective in routine healthcare settings, offering similar results to the RAPIDO trial, a key clinical study in this field. Conducted from July 2016 to June 2020 at 16 hospitals, the study involved 273 patients with high-risk LARC, treated using a modified RAPIDO schedule. Another 189 patients were treated similarly at 18 hospitals.
Participants received short-course radiotherapy followed by chemotherapy (either CAPOX or FOLFOX-6) before undergoing surgery or being placed in a “watch-and-wait” protocol if a clinical complete response (cCR) was achieved. The primary outcome was complete response (CR), combining pathological complete response (pCR) and sustained cCR.
The findings revealed a 24% CR rate in the main group and 23% in the secondary cohort, aligning closely with the RAPIDO trial, despite the Swedish patients being older and having more advanced tumours. Importantly, the study recorded fewer side effects, particularly lower neurotoxicity, compared to RAPIDO.
With only one treatment-associated death and a low rate of local recurrence (6% and 5% in the two groups), researchers concluded that the modified TNT schedule is safe and effective. The results demonstrate that two fewer chemotherapy cycles did not compromise outcomes, offering a favourable option for real-world application in Sweden.
Helena Bradbury, EMJ
Reference
Glimelius B et al. Total neoadjuvant treatment using short-course radiotherapy and four CAPOX cycles in locally advanced rectal cancer with high-risk criteria for recurrence: a Swedish nationwide cohort study (LARCT-US). eClinical Medicine. 2024;(75):102771.
