直腸癌と術前導入療法に続く専用手術。 RAPIDOトライアル (RAPIDO)
原発性高リスク直腸癌における短期コース放射線療法とその後の長期術前化学療法および手術の無作為化多施設共同第 III 相試験と、標準的な化学放射線療法および手術および任意の補助化学療法との比較。
調査の概要
詳細な説明
研究の種類
入学 (実際)
段階
- フェーズ 3
連絡先と場所
研究場所
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Missouri
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St Louis、Missouri、アメリカ、63110
- Siteman Cancer Center, Washington University Medical School
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Alkmaar、オランダ
- Noordwest Ziekenhuisgroep
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Amsterdam、オランダ
- Onze Lieve Vrouwe Gasthuis
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Amsterdam、オランダ
- Amsterdam UMC, location AMC
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Amsterdam、オランダ
- Amsterdam UMC, location VUmc
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Amsterdam、オランダ
- Nki / Avl
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Assen、オランダ
- Wilhelmina ziekenhuis
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Breda、オランダ
- Amphia Ziekenhuis
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Delft、オランダ
- Reinier de Graaf Groep
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Deventer、オランダ
- Deventer Hospital
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Eindhoven、オランダ
- Catharina Ziekenhuis
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Gouda、オランダ
- Het Groene Hart Ziekenhuis
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Groningen、オランダ
- Martini Ziekenhuis
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Groningen、オランダ
- Universitair Medisch Centrum Groningen
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Heerenveen、オランダ
- de Tjongerschans
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Hengelo、オランダ
- Ziekenhuisgroep Twente
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Hoofddorp、オランダ
- Spaarne Ziekenhuis
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Leeuwarden、オランダ
- Medisch Centrum Leeuwarden
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Leeuwarden、オランダ
- Radiotherapeutisch Instituut Friesland
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Leiden、オランダ
- Leiden University Medical Center
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Leiderdorp、オランダ
- Alrijne Ziekenhuis
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Nijmegen、オランダ
- UMC Nijmegen St Radboud
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Sneek、オランダ
- Antonius ziekenhuis
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The Hague、オランダ
- HagaZiekenhuis
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The Hague、オランダ
- Bronovo Ziekenhuis
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The Hague、オランダ
- Medisch Centrum Haaglanden
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Utrecht、オランダ
- Diakonessenhuis
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Zwolle、オランダ
- Isala Klinieken
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PO BOX 30001
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Groningen、PO BOX 30001、オランダ、9700 RB
- University Medical Center Groningen
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Borås、スウェーデン
- Södra Älvsborgs Sjukhus
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Eskilstuna、スウェーデン
- Mälarsjukhuset
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Falun、スウェーデン
- Falu Lasarett
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Gothenburg、スウェーデン
- Sahlgrenska Universitetssjukhuset
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Gävle、スウェーデン
- Gävle Sjukhus
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Kalmar、スウェーデン
- Kalmar Hospital
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Karlstad、スウェーデン
- Centralsjukhuset i Karlstad
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Linköping、スウェーデン
- Linköpings Universitet
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Lund、スウェーデン
- Universitetssjukhuset i Lund
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Skövde、スウェーデン
- Skaraborgs Sjukhus
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Stockholm、スウェーデン
- Karolinska Universitetssjukhuset
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Sundsvall、スウェーデン
- Sundsvalls sjukhus
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Umeå、スウェーデン
- Norrlands universitetssjukhus
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Uppsala、スウェーデン
- Akademiska Sjukhuset
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Vaxjo、スウェーデン
- Centrallasarettet Växjö
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Västerås、スウェーデン
- Centrallasarett
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Örebro、スウェーデン
- Universitetssjukhuset Orebro
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Barcelona、スペイン
- Hospital Vall d'hebrón
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L'Hospitalet de Llobregat、スペイン
- ICO Hospital Duran i Reynals
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Valencia、スペイン
- Hospital Clínico Universitario de Valencia
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Valencia、スペイン
- Hospital Universitari i Politecnic La Fe
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Valencia、スペイン
- Consorcio Hospital General Universitario Valencia
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Ljubljana、スロベニア
- Institute of Oncology
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Aalborg、デンマーク
- Aalborg Universitetshospital
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Odense、デンマーク
- Odense Universitetshospital
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Kristiansand、ノルウェー
- Sørlandet Sykehus Kristiansand
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Oslo、ノルウェー
- Oslo Universitetssykehus
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
説明
包含基準:
原発腫瘍の特徴:
- 直腸の新たに診断された原発性腺癌の組織学的証拠
- -骨盤MRIで次の基準の少なくとも1つを満たす局所進行腫瘍は、局所的および/または全身的に失敗するリスクが高いことを示しています(T4a、つまり、前立腺、膀胱、子宮、仙骨、骨盤底または側面などの隣接する臓器または構造への過成長壁 (TNM バージョン 5 による)、cT4b、すなわち腹膜浸潤、壁外血管浸潤 (EMVI+)。 N2、すなわち、転移性疾患を示す MRI で形態学的徴候を示す直腸間膜の 4 つ以上のリンパ節。 MRF陽性、すなわち直腸間膜筋膜から1mm未満の腫瘍またはリンパ節。 外側結節の拡大、> 1 cm (lat LN+)
除外基準:
- 仙骨の頭蓋部分(S3より上)または腰仙神経根への広範な成長は、実質的な腫瘍の縮小が見られたとしても手術が不可能であることを示しています
- -転移性疾患または再発性直腸腫瘍の存在
- 家族性腺腫症 大腸ポリポーシス (FAP)、遺伝性非ポリポーシス結腸直腸癌 (HNPCC)、活動性クローン病または活動性潰瘍性大腸炎
- -適切に治療された皮膚の基底細胞がんまたは子宮頸部の上皮内がんを除く、付随する悪性腫瘍。 -以前に悪性腫瘍のある被験者は、少なくとも5年間無病でなければなりません
- 既知のDPD欠乏症
- -MRIの禁忌(例: ペースメーカー装着患者)
- -インフォームドコンセントを与える患者の能力を損なう医学的または精神医学的状態
- 同時に制御されていない病状
- -過去1か月以内の直腸がんの治験治療
- 妊娠中または授乳中
- -既知の吸収不良症候群または上部消化管の物理的完全性の欠如を有する患者
- 臨床的に重要な (すなわち アクティブ) 心疾患 (例: うっ血性心不全、症候性冠動脈疾患、不整脈など。 -心房細動、たとえ薬物で制御されていても)または過去12か月以内の心筋梗塞
- 末梢神経障害の症状または病歴のある患者
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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実験的:B: 5x5Gy -> CAPOX -> surgery
experimental group (arm B) M1 scheme: 5 fractions of 5 Gy external beam radiation (5x5Gy) followed by CAPOX followed by TME surgery
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short course 5x5Gy radiation scheme is followed by six cycles of combination chemotherapy (capecitabine and oxaliplatin (CAPOX)) and surgery.
FOLFOX4 may be given as alternative for CAPOX
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アクティブコンパレータ:A: 5 weeks chemoradiation -> surgery
control group (arm A) standard long course chemoradiotherapy followed by TME surgery
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長期化学放射線療法とその後の手術。
対照群では、オプションの補助化学療法(CAPOX または FOLFOX)が許可されます。
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Number of Patients With Disease Related Treatment Failure (DrTF)
時間枠:3 years follow-up after surgery
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DrTF = Either local or distant relapse or death caused by the rectal carcinoma whichever comes first.
In case of nonrectal cancer related death patients will be censored at date of death.
In case of a second primary tumour patients will be censored at the date of diagnosis of the second primary tumour.
In case of local regrowth after wait & watch strategy, followed by no resection or R2 resection, diagnosis local regrowth is taken.
Patients lost to follow-up will be censored the last date of patient visit.
Survival curves for Disease related Treatment Failure after 3 years of follow-up will be constructed using the method of Kaplan and Meier.
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3 years follow-up after surgery
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Number of Patients Completing the Prescribe Neo-adjuvant Treatment Dose
時間枠:30 days after neoadjuvant treatment
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Number of patients in the experimental arm receiving 5 fractions of x 5 Gy (5x5Gy) radiotherapy followed by at least 75% of the prescribed chemotherapy. In the standard arm receiving the prescribed chemoradiotherapy. |
30 days after neoadjuvant treatment
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Number of Patients With Negative CRM Negative
時間枠:30 days after surgery
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Number of patients with a Circumferential Resection Margin (CRM) > 1 mm
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30 days after surgery
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Number of Patients With a Pathological Complete Response (pCR)
時間枠:30 days after surgery
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Number of patients with a Pathological Complete Response (pCR) after neo-adjuvant treatment
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30 days after surgery
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Number of Patients With Surgical Complications
時間枠:30 days after surgery
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Number of patients with surgical complications: wound rupture, bleeding, infection, rectal anastomotic leak
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30 days after surgery
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Quality of Life QLQ-C30 Scores
時間枠:3 year after surgery
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Quality of life QLQ-C30 core questionnaire EORTC quality-of-life instrument for use in international clinical trials in oncology A total Quality of Life Questionnaire (QLQ) score can range from 0 to 88, higher score means worse outcome.
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3 year after surgery
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Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy (EORTC-QLQ-CIPN20)
時間枠:3 year after surgery
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Quality of life EORTC-QLQ-CIPN20. International EORTC questionnaire to assess Chemotherapy-Induced Peripheral Neuropathy (CIPN). A total QLQ-CIPN20 score can range from 0 to 100, higher score means worse outcome. Chemotherapy-induced peripheral neuropathy (CIPN) is a common phenomenon, often resulting in serious limitations in daily functioning and compromised quality of life. |
3 year after surgery
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Quality of Life LARS Scores
時間枠:3 year after surgery
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Low Anterior Resection Syndrome (LARS) scores in patients without a stoma three years after curative surgery Patient reported score (5 questions). 0-12 no LARS, 21-29 Minor LARS, 30-42 Major LARS. Higher scores mean a worse outcome. |
3 year after surgery
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Number of Patients With a Locoregional Recurrence
時間枠:5 years after surgery
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Number of patients with a locoregional recurrence (LRR) after an R0/R1 resection
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5 years after surgery
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Overall Survival
時間枠:10 year
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Overall survival will be computed as the time between randomization and colorectal cancer or treatment related death. Patients lost to follow-up will be censored the last date of patient visit. In case of a second primary tumour patients will be censored at the date of diagnosis of the second primary tumour. |
10 year
|
協力者と研究者
協力者
捜査官
- 主任研究者:B. van Etten, MD, PhD、University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands
- 主任研究者:B. Glimelius, MD, PhD、Akademiska Sjukhuset, Department of Oncology, Uppsala, Sweden
- 主任研究者:G. A. Hospers, MD, PhD、University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
- 主任研究者:P. Nilsson, MD, PhD、Karolinska Universitetssjukhuset, Stockholm, Sweden
- 主任研究者:C. J. van de Velde, MD, PhD、Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands
- 主任研究者:C.A.M. Marijnen, MD, PhD、Netherlands Cancer Institute, Amsterdam, the Netherlands
出版物と役立つリンク
一般刊行物
- Nilsson PJ, van Etten B, Hospers GA, Pahlman L, van de Velde CJ, Beets-Tan RG, Blomqvist L, Beukema JC, Kapiteijn E, Marijnen CA, Nagtegaal ID, Wiggers T, Glimelius B. Short-course radiotherapy followed by neo-adjuvant chemotherapy in locally advanced rectal cancer--the RAPIDO trial. BMC Cancer. 2013 Jun 7;13:279. doi: 10.1186/1471-2407-13-279.
- Jimenez-Fonseca P, Salazar R, Valenti V, Msaouel P, Carmona-Bayonas A. Is short-course radiotherapy and total neoadjuvant therapy the new standard of care in locally advanced rectal cancer? A sensitivity analysis of the RAPIDO clinical trial. Ann Oncol. 2022 Aug;33(8):786-793. doi: 10.1016/j.annonc.2022.04.010. Epub 2022 Apr 22.
- Glynne-Jones R, Harrison M. Should the RAPIDO schedule represent standard of care in locally advanced rectal cancer? Ann Oncol. 2022 Aug;33(8):745-746. doi: 10.1016/j.annonc.2022.05.002. Epub 2022 May 12. No abstract available.
- Patel A, Spychalski P, Corrao G, Jereczek-Fossa BA, Glynne-Jones R, Garcia-Aguilar J, Kobiela J. Neoadjuvant short-course radiotherapy with consolidation chemotherapy for locally advanced rectal cancer: a systematic review and meta-analysis. Acta Oncol. 2021 Oct;60(10):1308-1316. doi: 10.1080/0284186X.2021.1953137. Epub 2021 Jul 24.
- Papaccio F, Rosello S, Huerta M, Gambardella V, Tarazona N, Fleitas T, Roda D, Cervantes A. Neoadjuvant Chemotherapy in Locally Advanced Rectal Cancer. Cancers (Basel). 2020 Dec 3;12(12):3611. doi: 10.3390/cancers12123611.
- Giunta EF, Bregni G, Pretta A, Deleporte A, Liberale G, Bali AM, Moretti L, Troiani T, Ciardiello F, Hendlisz A, Sclafani F. Total neoadjuvant therapy for rectal cancer: Making sense of the results from the RAPIDO and PRODIGE 23 trials. Cancer Treat Rev. 2021 May;96:102177. doi: 10.1016/j.ctrv.2021.102177. Epub 2021 Mar 16.
- Bahadoer RR, Dijkstra EA, van Etten B, Marijnen CAM, Putter H, Kranenbarg EM, Roodvoets AGH, Nagtegaal ID, Beets-Tan RGH, Blomqvist LK, Fokstuen T, Ten Tije AJ, Capdevila J, Hendriks MP, Edhemovic I, Cervantes A, Nilsson PJ, Glimelius B, van de Velde CJH, Hospers GAP; RAPIDO collaborative investigators. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021 Jan;22(1):29-42. doi: 10.1016/S1470-2045(20)30555-6. Epub 2020 Dec 7.
- Ozturk SK, Martinez CG, Mens D, Verhoef C, Tosetto M, Sheahan K, de Wilt JHW, Hospers GAP, van de Velde CJH, Marijnen CAM, van der Post RS, Nagtegaal ID. Lymph node regression after neoadjuvant chemoradiotherapy in rectal cancer. Histopathology. 2024 May;84(6):935-946. doi: 10.1111/his.15134. Epub 2024 Jan 8.
- Nilsson PJ, van Etten B, Hospers GAP, Marijnen CAM, Meershoek-Klein Kranenberg E, Roodvoets AGH, van de Velde CJH, Glimelius B. Comment on the RAPIDO Trial Point-Counterpoint Debate. Dis Colon Rectum. 2024 Feb 1;67(2):e126. doi: 10.1097/DCR.0000000000003138. Epub 2023 Oct 26. No abstract available.
- Polack M, van Pelt GW, van den Heuvel DH, Klein-Kranenbarg EM, Roodvoets AGH, Putter H, Crobach ASLP, Nagtegaal ID, Peeters KCMJ, Tollenaar RAEM, van Krieken JHJM, Mesker WE. The tumour-stroma ratio as predictive aid towards a biopsy-based treatment strategy in rectal carcinoma. Histopathology. 2025 Jul;87(1):44-57. doi: 10.1111/his.15423. Epub 2025 Apr 4.
- van der Valk MJM, Marijnen CAM, van Etten B, Dijkstra EA, Hilling DE, Kranenbarg EM, Putter H, Roodvoets AGH, Bahadoer RR, Fokstuen T, Ten Tije AJ, Capdevila J, Hendriks MP, Edhemovic I, Cervantes AMR, de Groot DJA, Nilsson PJ, Glimelius B, van de Velde CJH, Hospers GAP; Collaborative investigators. Compliance and tolerability of short-course radiotherapy followed by preoperative chemotherapy and surgery for high-risk rectal cancer - Results of the international randomized RAPIDO-trial. Radiother Oncol. 2020 Jun;147:75-83. doi: 10.1016/j.radonc.2020.03.011. Epub 2020 Mar 30.
- Dijkstra EA, Hospers GAP, Kranenbarg EM, Fleer J, Roodvoets AGH, Bahadoer RR, Guren MG, Tjalma JJJ, Putter H, Crolla RMPH, Hendriks MP, Capdevila J, Radu C, van de Velde CJH, Nilsson PJ, Glimelius B, van Etten B, Marijnen CAM. Quality of life and late toxicity after short-course radiotherapy followed by chemotherapy or chemoradiotherapy for locally advanced rectal cancer - The RAPIDO trial. Radiother Oncol. 2022 Jun;171:69-76. doi: 10.1016/j.radonc.2022.04.013. Epub 2022 Apr 18.
- Dijkstra EA, Zwart WH, Putter H, Marijnen CAM, Nilsson PJ, van de Velde CJH, van Etten B, Hospers GAP, Glimelius B. Authors' reply-A sensitivity analysis of the RAPIDO clinical trial. Ann Oncol. 2023 Apr;34(4):446-447. doi: 10.1016/j.annonc.2022.12.012. Epub 2022 Dec 26. No abstract available.
- Dijkstra EA, Nilsson PJ, Hospers GAP, Bahadoer RR, Meershoek-Klein Kranenbarg E, Roodvoets AGH, Putter H, Berglund A, Cervantes A, Crolla RMPH, Hendriks MP, Capdevila J, Edhemovic I, Marijnen CAM, van de Velde CJH, Glimelius B, van Etten B; Collaborative Investigators. Locoregional Failure During and After Short-course Radiotherapy Followed by Chemotherapy and Surgery Compared With Long-course Chemoradiotherapy and Surgery: A 5-Year Follow-up of the RAPIDO Trial. Ann Surg. 2023 Oct 1;278(4):e766-e772. doi: 10.1097/SLA.0000000000005799. Epub 2023 Jan 20.
- Bahadoer RR, Hospers GAP, Marijnen CAM, Peeters KCMJ, Putter H, Dijkstra EA, Kranenbarg EM, Roodvoets AGH, van Etten B, Nilsson PJ, Glimelius B, van de Velde CJH; collaborative investigators. Risk and location of distant metastases in patients with locally advanced rectal cancer after total neoadjuvant treatment or chemoradiotherapy in the RAPIDO trial. Eur J Cancer. 2023 May;185:139-149. doi: 10.1016/j.ejca.2023.02.027. Epub 2023 Mar 7.
- Kus Ozturk S, Graham Martinez C, Sheahan K, Winter DC, Aherne S, Ryan EJ, van de Velde CJ, Marijnen CA, Hospers GA, Roodvoets AG, Doukas M, Mens D, Verhoef C, van der Post RS, Nagtegaal ID. Relevance of shrinkage versus fragmented response patterns in rectal cancer. Histopathology. 2023 Dec;83(6):870-879. doi: 10.1111/his.15027. Epub 2023 Aug 23.
- Zwart WH, Temmink SJD, Hospers GAP, Marijnen CAM, Putter H, Nagtegaal ID, Blomqvist L, Kranenbarg EM, Roodvoets AGH, Martling A, van de Velde CJH, Glimelius B, Peeters KCMJ, van Etten B, Nilsson PJ; Collaborative investigators. Oncological outcomes after a pathological complete response following total neoadjuvant therapy or chemoradiotherapy for high-risk locally advanced rectal cancer in the RAPIDO trial. Eur J Cancer. 2024 Jun;204:114044. doi: 10.1016/j.ejca.2024.114044. Epub 2024 Apr 7.
- Zwart WH, Dijkstra EA, Putter H, Marijnen CAM, Nilsson PJ, van de Velde CJH, van Etten B, Hospers GAP, Glimelius B. Authors' reply-Does the RAPIDO trial suggest a benefit of post-operative chemotherapy after preoperative chemoradiation in rectal cancer? No, it does not. ESMO Open. 2023 Oct;8(5):101645. doi: 10.1016/j.esmoop.2023.101645. Epub 2023 Sep 14. No abstract available.
- Zwart WH, Dijkstra EA, Putter H, Marijnen CAM, Nilsson PJ, van de Velde CJH, van Etten B, Hospers GAP, Glimelius B. Corrigendum to "Authors' reply-Does the RAPIDO trial suggest a benefit of post-operative chemotherapy after preoperative chemoradiation in rectal cancer? No, it does not": [ESMO Open 8 (2023) 101645]. ESMO Open. 2023 Dec;8(6):102042. doi: 10.1016/j.esmoop.2023.102042. Epub 2023 Oct 20. No abstract available.
- Bahadoer RR, Dijkstra EA, van Etten B, Marijnen CAM, Putter H, Kranenbarg EM, Nilsson PJ, Glimelius B, van de Velde CJH, Hospers GAP. Interpreting the RAPIDO trial: factors to consider - Authors' reply. Lancet Oncol. 2021 Mar;22(3):e90-e91. doi: 10.1016/S1470-2045(21)00087-5. No abstract available.
- Dijkstra EA, Zwart WH, Nilsson PJ, Putter H, Roodvoets AGH, Meershoek-Klein Kranenbarg E, Frodin JE, Nygren P, Ostergaard L, Kersten C, Verbiene I, Cervantes A, Hendriks MP, Capdevila J, Edhemovic I, van de Velde CJH, Marijnen CAM, van Etten B, Hospers GAP, Glimelius B; collaborative investigators. The value of post-operative chemotherapy after chemoradiotherapy in patients with high-risk locally advanced rectal cancer-results from the RAPIDO trial. ESMO Open. 2023 Apr;8(2):101158. doi: 10.1016/j.esmoop.2023.101158. Epub 2023 Mar 3.
- Prata I, Eriksson M, Krdzalic J, Kranenbarg EM, Roodvoets AGH, Beets-Tan R, van de Velde CJH, van Etten B, Hospers GAP, Glimelius B, Nilsson PJ, Marijnen CAM, Peeters KCMJ, Blomqvist LK. Results of a diagnostic imaging audit in a randomised clinical trial in rectal cancer highlight the importance of careful planning and quality control. Insights Imaging. 2023 Nov 24;14(1):206. doi: 10.1186/s13244-023-01552-0.
- Ozturk SK, Bokhorst JM, Baumann E, Sheahan K, van de Velde CJH, Marijnen CAM, Hospers GAP, Doukas M, Vieth M, Lugli A, Nagtegaal ID. Exploring Intratumoral Budding in Colorectal Cancer Using Computational Pathology: A Biopsy-Based Evaluation. Mod Pathol. 2025 Feb;38(2):100655. doi: 10.1016/j.modpat.2024.100655. Epub 2024 Nov 9.
- Zwart WH, Dijkstra EA, Hospers GAP, Marijnen CAM, Putter H, Folkesson J, Van de Velde CJH, Roodvoets AGH, Meershoek-Klein Kranenbarg E, Glimelius B, Van Etten B, Nilsson PJ. Perineal wound complications after total neoadjuvant therapy or chemoradiotherapy followed by abdominoperineal excision in patients with high-risk locally advanced rectal cancer in the RAPIDO trial. BJS Open. 2025 Mar 4;9(2):zraf043. doi: 10.1093/bjsopen/zraf043.
- Tanaka MD, Glimelius B, Hospers GAP, Kranenbarg EM, Marijnen CAM, Putter H, Roodvoets AGH, van de Velde CJH, van Etten B, Nilsson PJ, Couwenberg AM. Acute and Late Radiation-Related Toxicity After Treatment of Locally Advanced Rectal Cancer With Intensity Modulated Radiation Therapy Compared With 3-Dimensional Conformal Radiation Therapy in the RAPIDO Trial. Int J Radiat Oncol Biol Phys. 2025 Oct 1;123(2):470-482. doi: 10.1016/j.ijrobp.2025.04.035. Epub 2025 May 10.
便利なリンク
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (推定)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (推定)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。