Total Neoadjuvant Therapy With Additional Consolidation Chemotherapy Followed by Local Excision Versus Total Neoadjuvant Therapy Followed by Local Excision at Stage I Rectal Cancer (OPTION)

April 26, 2026 updated by: Ryoo, Seung-Bum, Seoul National University Hospital

Safety and Efficacy of Organ Preservation Treatment for Stage I Rectal Cancer: Optimization of Consolidation Chemotherapy Before Local Excision After Neoadjuvant Chemoradiotherapy (OPTION); A Multi-center, Prospective, Randomized Trial

Safety and Efficacy of Organ Preservation Treatment for Stage I Rectal Cancer: Optimization of Consolidation Chemotherapy Before Local Excision After Neoadjuvant Chemoradiotherapy (OPTION); A Multi-center, Prospective, Randomized Trial

The goal of this clinical trial is to find out if adding consolidation chemotherapy with capecitabine after total neoadjuvant chemoradiotherapy (TNT) works to improve oncologic outcomes in patients with stage I rectal cancer. It will also comparethe safety of adding consolidation chemotherapy before local excision.

The main questions it aims to answer are:

  • Does adding consolidation chemotherapy increase the rate of pathologic complete response?
  • What medical problems or side effects do participants have during and after treatment?

Researchers will compare TNT followed by local excision to TNT followed by consolidation chemotherapy with capecitabine and then local excision to see if adding consolidation chemotherapy improves tumor response and treatment outcomes.

Participants will:

  • Receive TNT for stage I rectal cancer
  • Be randomly assigned to one of two treatment groups
  • Undergo local excision after preoperative treatment
  • Visit the clinic for checkups and tests to evaluate tumor response, side effects, recurrence, survival, quality of life, bowel function, urinary function, sexual function, circulating tumor DNA, and treatment-related costs

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

292

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • South Korea
    • Jongro-gu
      • Seoul, Jongro-gu, South Korea, 03080
        • Seoul National University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Histologically confirmed rectall adenocarcinoma
  • Low rectal cancer (AV < 15cm)
  • cT2N0 disease, or pathologic stage T1N0 disease after endoscopic resection with at least one high-risk feature, including: Positive resection margin Lymphovascular invasion Tumor budding ≥5
  • Ability to understand and comply with the requirements of the clinical trial

Exclusion Criteria:

  • Patients who prefer radical rectal resection
  • Prior history of surgery for rectal cancer
  • Recurrent rectal cancer
  • Synchronous metastatic rectal cancer
  • Evidence of lymph node metastasis or distant metastasis on abdominopelvic CT or chest CT, including para-aortic, common iliac, or external iliac lymph node metastasis
  • Uncontrolled active infection or other uncontrolled medical condition
  • Known hypersensitivity to chemotherapy
  • Patients considered unsuitable for participation in the clinical trial by the principal investigator or study personnel

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: TNT with consolidation therapy
Drug: TNT with additional consolidation chemotherapy followed by local excision
5-FU based CCRT: 5 weeks Rest period: 1 week 5-FU (Capecitabine) Consolidation chemotherapy 3 cycles: 8 weeks Rest period: 1 week Local excision
Active Comparator: TNT without consolidation therapy
Drug: TNT followed by local excision
5-FU based CCRT: 5 weeks Rest period: 10 weeks Local excision

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pathologic complete response rate (ypT0)
Time Frame: At pathologic assessment of the local excision specimen, approximately 10 weeks after completion of TNT
Pathologic complete response of the primary tumor after neoadjuvant therapy
At pathologic assessment of the local excision specimen, approximately 10 weeks after completion of TNT

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
5-year Survival Rate
Time Frame: 5 years
5-year Overall survival & 5-year Recurrence free survival
5 years
Low anterior resection syndrome (LARS)
Time Frame: After local excision
0-20, no / 21-29, minor / 30-42, major
After local excision
EORTC-QLQ, C30 score
Time Frame: After local excision, 4weeks
Quality of life surveillance
After local excision, 4weeks
Total medical costs
Time Frame: 5 years
Total medical costs related to treatment, including chemoradiotherapy, chemotherapy, local excision, follow-up examinations, management of treatment-related complications, and additional treatment for recurrence, if applicable.
5 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Seoul National University Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

June 1, 2026

Primary Completion (Estimated)

December 31, 2030

Study Completion (Estimated)

December 31, 2035

Study Registration Dates

First Submitted

April 26, 2026

First Submitted That Met QC Criteria

April 26, 2026

First Posted (Actual)

May 4, 2026

Study Record Updates

Last Update Posted (Actual)

May 4, 2026

Last Update Submitted That Met QC Criteria

April 26, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2603-018-1725

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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