For locally advanced rectal cancer, would you consider utilizing the RAPIDO trial approach of short course radiation followed by neoadjuvant chemotherapy prior to surgery?  

RAPIDO trial is an important study since it is the first phase III study that reported final results of a total neoadjuvant treatment (TNT) approach for rectal cancer.The RAPIDO study is a European study and we need to be aware of the practice difference (in the US, we traditionally use neoadjuvant ...

I need to disagree with Dr. @Zhaohui Jin, who I think has misquoted the local-regional failure rate in the two treatment arms. The 17% vs 10% local failure that he quotes is the percent of patients with LR recurrence in the patients who recurred. If there are fewer distant mets with TNT, then there ...

Nice discussion. I think the elephant in the room is the distant/systemic failure, which kills most patients who die from rectal cancer. It is hard to infer the impact of systemic therapy from the RAPIDO trial data. However, the UNICANCER-PRODIGE 23 data provide direct evidence that 'Intensification...

Thanks a lot for the great input @Joel E. Tepper and @Parag J. Parikh. RAPIDO, although enrolled 20 US patients, the study design and vast majority of the patients were in Europe and I would pay more attention to the enrollment criteria which is clearly consistent with ESMO guidelines which is ...

Very animated and indeed enjoyable discussion as it highlights the controversy surrounding the current management of locally advanced rectal cancer and although, we have made strides in the past two decades or so in this disease, we still have work to do. Thanks to all for your various perspectives.