Top Line: Three-year outcomes of the OPRA trial demonstrated the superiority of sequencing chemoradiation followed by chemo as upfront treatment of stage II-III rectal cancer, rendering half of patients free from disease without ever undergoing total mesorectal excision (TME).
The Study: We now have five-year outcomes confirming almost no late recurrences. Recall the primary endpoint of disease-free survival was identical across arms and similar to historic controls. After a median follow-up surpassing 5 years, disease-free survival at 5 years was 71% with chemo first and 69% with chemoradiation first. The more interesting outcome, the secondary endpoint of TME-free survival, was 39% versus 54% at 5 years. Importantly, of 81 occurrences of tumor regrowth during a watch and wait approach, 94% occurred within 2 years and 99% occurred within 3 years.
TBL: Longer follow-up confirms total neoadjuvant therapy with chemoradiation followed by chemo for stage II-III rectal cancer results in over half of patients achieving long term freedom from disease without need for TME, and most recurrences happen within the first two years. | Verheij, J Clin Oncol 2023
The Study: We now have five-year outcomes confirming almost no late recurrences. Recall the primary endpoint of disease-free survival was identical across arms and similar to historic controls. After a median follow-up surpassing 5 years, disease-free survival at 5 years was 71% with chemo first and 69% with chemoradiation first. The more interesting outcome, the secondary endpoint of TME-free survival, was 39% versus 54% at 5 years. Importantly, of 81 occurrences of tumor regrowth during a watch and wait approach, 94% occurred within 2 years and 99% occurred within 3 years.
TBL: Longer follow-up confirms total neoadjuvant therapy with chemoradiation followed by chemo for stage II-III rectal cancer results in over half of patients achieving long term freedom from disease without need for TME, and most recurrences happen within the first two years. | Verheij, J Clin Oncol 2023