Compliance and tolerability of short-course radiotherapy followed by preoperative chemotherapy and surgery for high-risk rectal cancer – Results of the international randomized RAPIDO-trial

Valk, Maxime J M van der; Marijnen, Corrie A.M.; Etten, Boudewijn van; Dijkstra, Esmée A.; Hilling, Denise E.; Kranenbarg, Elma Meershoek-Klein; Putter, Hein; Roodvoets, Annet G.H.; Bahadoer, Renu R.; Fokstuen, Tone; Tije, Albert J. ten; Capdevila, Jaume; Hendriks, Mathijs P.; Edhemović, Ibrahim; Cervantes, Andrés; Groot, Derk Jan A. de; Nilsson, Per J.; Glimelius, Bengt; Velde, Cornelis J.H. van de; Hospers, Geke A.P.

doi:10.1016/j.radonc.2020.03.011

Cited by 163 publications

(159 citation statements)

References 33 publications

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“…The approach in the RAPIDO trial for patients with high-risk rectal cancer of SCPRT followed by chemotherapy (6 cycles of CAPOX [capecitabine, oxaliplatin] or 9 cycles of FOLFOX-4 [folinic acid, 5-fluorouracil, oxaliplatin]) and subsequent surgery could be a surgical option during the COVID-19 pandemic. 46 However, the primary endpoint and long-term outcomes with this approach have not yet been determined from the trial. 46 In patients who have completed chemoradiotherapy and require surgery, one option could be to extend the interval to surgery to 14 to 16 weeks if the restaging magnetic resonance imaging findings after neoadjuvant therapy have demonstrated favorable tumor regression.…”

Section: Covid-19 Effects On Colorectal Practicementioning

confidence: 99%

“…46 However, the primary endpoint and long-term outcomes with this approach have not yet been determined from the trial. 46 In patients who have completed chemoradiotherapy and require surgery, one option could be to extend the interval to surgery to 14 to 16 weeks if the restaging magnetic resonance imaging findings after neoadjuvant therapy have demonstrated favorable tumor regression. Favorable tumor regression has generally been associated with good overall and disease-free survival.…”

Section: Covid-19 Effects On Colorectal Practicementioning

confidence: 99%

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COVID-19 and the Global Impact on Colorectal Practice and Surgery

Nunoo‐Mensah

Rizk

Caushaj

et al. 2020

Clinical Colorectal Cancer

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We have presented the results of a survey used to assess the global impact of coronavirus disease 2019 (COVID-19) on the delivery of colorectal surgery. Despite accessible guidance information, our results have demonstrated that COVID-19 has significantly affected the ability of colorectal surgeons to offer care to patients. We have also discussed practical adaptation strategies for use during the recovery phase. Background: The novel severe acute respiratory syndrome coronavirus 2 virus that emerged in December 2019 causing coronavirus disease 2019 (COVID-19) has led to the sudden national reorganization of health care systems and changes in the delivery of health care globally. The purpose of our study was to use a survey to assess the global effects of COVID-19 on colorectal practice and surgery. Materials and Methods: A panel of International Society of University Colon and Rectal Surgeons (ISUCRS) selected 22 questions, which were included in the questionnaire. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in the ISUCRS database and was advertised on social media sites. The questionnaire remained open from April 16 to 28, 2020. Results: A total of 287 surgeons completed the survey. Of the 287 respondents, 90% were colorectal specialists or general surgeons with an interest in colorectal disease. COVID-19 had affected the practice of 96% of the surgeons, and 52% were now using telemedicine. Also, 66% reported that elective colorectal cancer surgery could proceed but with perioperative precautions. Of the 287 respondents, 19.5% reported that the use of personal protective equipment was the most important perioperative precaution. However, personal protective equipment was only provided by 9.1% of hospitals. In addition, 64% of surgeons were offering minimally invasive surgery. However, 44% reported that enough information was not available regarding the safety of the loss of intra-abdominal carbon dioxide gas during the COVID-19 pandemic. Finally, 61% of the surgeons were prepared to defer elective colorectal cancer surgery, with 29% willing to defer for 8 weeks. Conclusion: The results from our survey have demonstrated that, globally, COVID-19 has affected the ability of colorectal surgeons to offer care to their patients. We have also discussed suggestions for various practical adaptation strategies for use during the recovery period.

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Section: Covid-19 Effects On Colorectal Practicementioning

confidence: 99%

Section: Covid-19 Effects On Colorectal Practicementioning

confidence: 99%

COVID-19 and the Global Impact on Colorectal Practice and Surgery

Nunoo‐Mensah

Rizk

Caushaj

et al. 2020

Clinical Colorectal Cancer

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“…Reported pCR rates ranged from 14 to 37% (weighted average 21%) in the TNT arms compared to 11–25% (weighted average 14%) in the standard chemoradiation arms of the comparative studies, indicating the superiority of the TNT approach. Moreover, the largest randomized trials observed significant benefits in terms of disease-free in the TNT arms mainly attributed to a reduction of distant failures [ 24 , 156 , 160 – 162 ], although using slightly different approaches. The Timing of Rectal Cancer Response to Chemoradiation Consortium in the United States [ 24 , 156 ] performed a sequential cohort phase II study including 259 patients with T3/4 or nodal positive patients.…”

Section: Neoadjuvant Treatment Intensificationmentioning

confidence: 99%

“…The significant OS benefit at 3 years (73% vs 65%) [ 157 ] disappeared with longer-follow-up [ 20 ]. The RAPIDO group [ 160 , 161 ] used a similar approach randomizing 911 patients with high risk rectal cancer (defined as cT4, cN2, EMVI+, MRF+ or positive lateral nodes) to either long-course chemoradiation (50,4 Gy + Capecitabine) or 5 × 5 Gy followed by six cycles of consolidation chemotherapy with CAPOX or nine cycles of FOLFOX [ 160 ]. They found significantly improved pCR rates (28% vs 14%) favoring the TNT arm, which came at the cost of significantly increased acute grade 3+ toxicity (48% vs 25%) [ 160 , 161 ].…”

Section: Neoadjuvant Treatment Intensificationmentioning

confidence: 99%

Recent advances in (chemo-)radiation therapy for rectal cancer: a comprehensive review

et al. 2020

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The role of radiation therapy in the treatment of (colo)-rectal cancer has changed dramatically over the past decades. Introduced with the aim of reducing the high rates of local recurrences after conventional surgery, major developments in imaging, surgical technique, systemic therapy and radiation delivery have now created a much more complex environment leading to a more personalized approach. Functional aspects including reduction of acute or late treatment-related side effects, sphincter or even organ-preservation and the unsolved problem of still high distant failure rates have become more important while local recurrence rates can be kept low in the vast majority of patients. This review summarizes the actual role of radiation therapy in different subgroups of patients with rectal cancer, including the current standard approach in different subgroups as well as recent developments focusing on neoadjuvant treatment intensification and/or non-operative treatment approaches aiming at organ-preservation.

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“…Thus, it appears that TNT is a safe option for the optimal delivery of recommended therapies for rectal cancer. 30 Perhaps the most relevant trial is the Timing of Rectal Cancer Response to Chemoradiation Consortium trial, in which neoadjuvant radiotherapy was administered, followed by 0, 2, 4, or 6 cycles of chemotherapy (mFOLFOX6). 31 Authors found that a longer duration of chemotherapy achieved greater rates of pathologic complete response, but unlike the findings in the GRECCAR-6 study, increased time after radiation was not associated with surgical complications.…”

Section: Stage Imentioning

confidence: 99%

Caring for Patients with Rectal Cancer During the COVID-19 Pandemic

Skowron

Hurst

Umanskiy

et al. 2020

Journal of Gastrointestinal Surgery

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The extraordinary spread of the novel coronavirus (COVID-19) has dramatically and rapidly changed the way in which we provide medical care for patients with all diagnoses. Conservation of resources, social distancing, and the risk of poor outcomes in COVID-19-positive cancer patients have forced practitioners and surgeons to completely rethink routine care. The treatment of patients with rectal cancer requires both a multidisciplinary approach and a significant amount of resources. It is therefore imperative to rethink how rectal cancer treatment can be aligned with the current COVID-19 pandemic paradigms. In this review, we discuss evidence-based recommendations to optimize oncological outcomes during the COVID-19 pandemic.

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Compliance and tolerability of short-course radiotherapy followed by preoperative chemotherapy and surgery for high-risk rectal cancer – Results of the international randomized RAPIDO-trial

Cited by 163 publications

References 33 publications

COVID-19 and the Global Impact on Colorectal Practice and Surgery

COVID-19 and the Global Impact on Colorectal Practice and Surgery

Recent advances in (chemo-)radiation therapy for rectal cancer: a comprehensive review

Caring for Patients with Rectal Cancer During the COVID-19 Pandemic

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