Implementing RAPIDO Protocol for Total Neoadjuvant Treatment of Carcinoma Rectum: A Real Life Experience from a Tertiary Care Cancer Center in India.

PURPOSE: Total Neoadjuvant treatment (TNT) has now become the standard of care in locally advanced rectal cancer(LARC) and has shown promising results. However, use and outcome of different TNT regimens in real-world practice is largely unknown.Here we report the feasibility and efficacy of RAPIDO regimen which we adopted since 2021 for LARC. MATERIALS AND METHODS: A retrospective review of prospectively collected data, conducted at Tata Medical Center, Kolkata between January 2021 to June 2024. 95 consecutive patients with localized rectal adenocarcinoma, treated with short course radiotherapy 25 Gy/5frs/1week followed by CAPOX based chemotherapy with or without surgery were analysed. Data was collected in the Redcap Database. RESULTS: The median age of the cohort was 53 years. Lower rectal disease, T4,N2,EMVI(Extramural Vascular Invasion) Grade 3/4, MRF (Mesorectal fascia) involvement were seen in 51(54%), 21(22.1%), 86(90.5%), 58(61%) and 70 (73.7%)patients respectively.62 patients (65.2%) underwent surgery. Pathological complete response (pCR) was achieved in 27.4%(17/62) cases. At a median follow-up of 2.4 years,43 patients (45.3%) underwent TNT and surgery and are disease free on follow up. Local failure was seen in 2 patients after surgery(3.2%)0.17 of 62 patients (27.4%) who underwent surgery developed distant metastasis with lung being the most common site (16.1%). The estimated 3 year overall survival of all patients was 83% and for patients who underwent surgery 3-year OS was 92% and 3-year disease free survival(DFS) was 63% Maximum grade≥ 3 diarrhoea and febrile neutropenia during chemotherapy were observed in 17 (17.9%) and 14 (14.7%) patients respectively. CONCLUSION: RAPIDO protocol in real world settings shows excellent response rates in LARC. It is a safe and feasible approach, however implementing a prolonged neoadjuvant treatment in the real world remains a challenge because of suboptimal compliance.