Preferred sequence of CRT and CT in neoadjuvant therapy for locally advanced rectal cancer

The multicenter randomized phase 2 CAO/ARO/AIO-12 study in Germany randomized patients with locally advanced rectal cancer to neoadjuvant chemoradiotherapy (CRT) followed by chemotherapy (CT) or CT followed by CRT. The primary analysis, published in 2019, showed that CRT followed by CT resulted in higher pathological complete response. Secondary analysis of the study shows that the sequence CRT followed by CT did not compromise disease-free survival, toxicity, quality of life, or stool incontinence. The authors conclude that CRT followed by CT is the preferred neoadjuvant therapy sequence if organ preservation is a priority.