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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?

How do you reconcile RAPIDO and OPRA trial results? OPRA was a Watch and Wait trial but the rectum preservation rate was much higher in that study than the pCR rate in RAPIDO. Have the OPRA results influenced your decision to recommend chemoradiation vs short course RT in patients committed to TNT and surgery?
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What is your default fractionation scheme for locally advanced rectal cancer in the context of TNT (for a patient with no transportation issues)?

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4 Answers
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Radiation Oncology · Memorial Sloan-Kettering Cancer Center
Answered on · Updated on

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 ...

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Radiation Oncology · Fox Chase Cancer Center
Answered on

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 ...

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Radiation Oncology · University of Nebraska Medical Center
Answered on

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-...

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Radiation Oncology · Hôtel Dieu de Lévis - CISSS Chaudière-Appalaches
Answered on

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)?

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