Have the results of the OPRA trial influenced your decision to recommend long course chemoradiation vs short course radiation therapy for patients receiving TNT who intend to undergo surgery?

The TME-free survival rate in the OPRA trial has solidified chemoradiation followed by consolidative chemotherapy as a standard in our practice. However, since the principal investigator is at our institution, it just meant that we continued doing what we were doing. It is important to realize that this is a bias and there's no direct comparison between that and other ways of giving TNT, including those that include SCRT, if nonoperative management is the goal. The difference between WW followin...

I agree with Dr. @Dr. First Last. LCCRT followed by chemotherapy is our standard for anyone in whom local control or organ preservation is a priority. While some will say that the chemo first arms do not have as good a response in the OPRA study or the CAO/ARO/AIO-12 study due to the decreased time from the end of chemoRT to surgery in the induction chemo arms, we do not have data demonstrating that a longer wait time will even these two arms.

For someone who is very much interested in non-surgical management, I do a long course CRT (not a short course RT) followed by chemotherapy. I believe that long course CRT followed by chemotherapy will have a higher PCR than a short course RT followed by chemotherapy although, we don't have head-to-head comparison data yet. The timing study showed the pCR rate can be as high as 38% but the short course RT followed by the chemotherapy regimen never showed a pCR rate as high as 38%. For RT dose, I...

Drs. @Dr. First Last, @Dr. First Last, and @Dr. First Last - Do you feel skeptical about using the short-course RT in light of the 5-year results of the RAPIDO trial showing more loco-regional recurrences in the experimental arm (despite this not being the primary endpoint)?