Radio- or Chemotherapy Dose Escalation for Organ Preservation in Rectal Cancer?

Garcia-Aguilar et al 1 reported the outcomes of the randomized phase II OPRA study on 324 patients with stage II or III rectal cancer treated with total neoadjuvant therapy (TNT, ie, chemoradiation [54 Gy] combined with either induction or consolidation chemotherapy delivered for 4 months).Better organ preservation rate was achieved in the consolidation chemotherapy group, in which the proportion of patients who preserved the rectum at 3 years was as high as 53%.These impressive results were achieved at the cost of grade 31 acute toxicity occurring during TNT in 34% of patients, including 2% of toxic deaths.