Locoregional failure during and after short-course radiotherapy followed by chemotherapy and surgery compared with long-course chemoradiotherapy and surgery:a 5-year follow-up of the RAPI-DO trial
Locoregional failure during and after short-course radiotherapy followed by chemotherapy and surgery compared with long-course chemoradiotherapy and surgery:a 5-year follow-up of the RAPI-DO trial
Objective To analyze risk and patterns of locoregional failure(LRF)in patients of the RAPIDO trial at 5 years.Background Multimodality treatment improves local control in rectal cancer.Total neoadjuvant treatment(TNT)aims to improve systemic control while local control is maintained.At 3 years,LRF rate was comparable between TNT and chemoradiotherapy in the RAPIDO trial.Methods A total of 920 patients were randomized between an experimental(EXP,short-course radiotherapy,chemotherapy,and surgery)and a standard-care group(STD,chemoradiotherapy,surgery,and optional postoperative chemotherapy).LRFs,including early LRF(no resection except for organ preservation/R2 resection)and locoregional recurrence(LRR)after an R0/R1 resection,were analyzed.Results Totally,460 EXP and 446 STD patients were eligible.At 5.6 years(median follow-up),LRF was detected in 54/460(12％)and 36/446(8％)patients in the EXP and STD groups,respectively(P=0.07),in which EXP patients were more often treated with 3-dimensional-conformed radiotherapy(P=0.029).In the EXP group,LRR was detected more often[44/431(10％)vs.26/428(6％);P=0.027],with more often a breached mesorectum(9/44(21％)vs.1/26(4);P=0.048).The EXP treatment,enlarged lateral lymph nodes,positive circumferential resection margin,tumor deposits,and node positivity at pathology were the significant predictors for developing LRR.Location of the LRRs was similar between groups.Overall survival af-ter LRF was comparable[hazard ratio:0.76(95％CI,0.46-1.26);P=0.29].Conclusions The EXP treatment was associated with an increased risk of LRR,whereas the reduction in disease-related treatment failure and distant metastases remained after 5 years.Further refinement of the TNT in rectal cancer is mandated.
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