With the RAPIDO trial demonstrating efficacy of short course XRT as part of TNT for locally advanced rectal cancer, is there a role for short course XRT to be integrated into watch and wait programs?

Great question, and one our group has discussed extensively.

Our group currently uses short course radiation nearly exclusively in the treatment of locally advanced rectal cancer. One notable exception (at least so far) is if the patient desires NOM. Our rationale is that there aren’t as many data for SCRT in this setting (and the organ preservation rates on OPRA presented at ASCO last summer were pretty impressive with LC-CRT-chemo).

At ASCO last summer; we learned about the impressive 28% pCR rate with SCRT-18wks chemo. Now with the publication of RAPIDO in manuscript form - we learned that there were actually 25 patients on RAPIDO who were followed with non-operative management (NOM) after cCR. Obviously, these numbers are too small to dr...

Great question and thank you for the shout-out, Dr. @Dr. First Last!

We completed the NORMAL-R (Non-Operative Radiation Management of Adenocarcinoma of the Lower Rectum - NCT02641691) trial. This small study of 19 patients evaluated the clinical complete response (cCR) rate at 1-year (primary endpoint) after SCRT and chemotherapy. Manuscript coming soon!

Due to the excellent early results from the NORMAL-R study, and decades of SCRT pioneered by my predecessors (Dr. @Dr. First Last, Dr. @Dr. First Last, and Dr. @Dr. First Last; PMID 24606849, PMID 28871992), we changed our institutional standard of care for rectal cancer to SCRT and consolidation chemotherapy with non-operative intent in early 2018. All patients were told that SCRT in combina...