How do you sequence chemoradiation and chemotherapy for patients with locally advanced rectal cancer undergoing TNT based upon data from CAO/ARO/AIO-12?

At our center, we give Total Neoadjuvant Therapy (TNT) for rectal cancer, with chemotherapy delivered up-front, followed by radiation (short-course vs long course chemo-XRT).

We do not use the CAO/ARO/AIO-12 study as a blueprint for our approach. CAO/ARO/AIO-12 was a phase II study of TNT evaluating FOLFOX, followed by 5-FU/oxaliplatin and XRT vs the other sequence. CR rates were highest in the XRT-first group (25% vs 17%), but long-term outcomes (PFS and OS) have not been reported. The importance of the findings from this phase II study are uncertain, as there is no well-defined role for oxaliplatin during chemoradiation for rectal cancer (particularly among patients receiving oxaliplatin-containing adjuvant or neoadjuvant chemotherapy), an...