Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

Total neoadjuvant therapy (TNT) in rectal cancer: the RAPIDO regimen

Short-course radiotherapy 5 × 5 Gy, then CAPOX or FOLFOX, then surgery

Updated: 28 October 20261 min read2 references

Summary for doctors

  • High-risk locally advanced rectal cancer (cT4, cN2, EMVI, involved MRF or lateral nodes) [1].
  • All chemotherapy is given before surgery [1].
  • In dMMR disease, immunotherapy before surgery is an option (article).

Dose and schedule

RAPIDO

High-risk rectal cancer

High-risk rectal cancer

DrugDoseRouteSchedule
Phase 1
Short-course radiotherapy5 Gy × 5 fractionsOne week
Phase 2: 6 cycles
Oxaliplatin130 mg/m²IVDay 1 every 21 days
Capecitabine1000 mg/m² twice a dayOralDays 1 to 14
Cycle length
CAPOX every 21 days (or FOLFOX4 every 14 days, 9 cycles)
Duration
Chemotherapy 11 to 18 days after radiotherapy; surgery 2 to 4 weeks after the last cycle

As in RAPIDO [1].

Evidence: RAPIDO (2021)

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Premedication and supportive care

  • DPYD: consider testing before the fluoropyrimidine [2].
  • Moderate antiemetics; avoid cold after oxaliplatin.

Monitoring and dose adjustment

  • Pelvic MRI before and after treatment; blood counts before each cycle.
  • Neuropathy; diarrhoea (radiotherapy and capecitabine).

Main evidence

Show detailsHide

RAPIDO: 3-year disease-related treatment failure 23.7% vs 30.4% with standard chemoradiotherapy; pathological complete response 28% vs 14% [1].

Related cancer types

Colorectal cancer

Treatment regimens (physicians)

FOLFOX (mFOLFOX6): dose, schedule and side effectsCAPOX (XELOX): dose, schedule and side effectsFOLFIRI regimen: dose, schedule and side effectsFOLFOXIRI with bevacizumab in metastatic bowel cancer

Physician tools and lessons

Colon Cancer TNM Staging Calculator (AJCC 8th Edition)10 cheap steps that save patients' livesGermline genetic testing in cancer: who, and which genes?

References

2 references
Show all references, 2 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    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 trialBahadoer RR, Dijkstra EA, van Etten B, et al · Lancet Oncol · 2021;22:29-42
    Study cardDOIPubMed Back to text: 1 2 3 4
  2. 2
    Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 UpdateAmstutz U, Henricks LM, Offer SM, et al · Clin Pharmacol Ther · 2018;103:210-216
    Study cardDOIPubMed Back to text

This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/rapido-total-neoadjuvant-rectal/

Related pages

27 October 2026 FOLFOX (mFOLFOX6): dose, schedule and side effects Dose and schedule of mFOLFOX6 (oxaliplatin 85, leucovorin 400, fluorouracil 400 bolus and 2400 as a 46-hour infusion), length of adjuvant treatment, premedication, neuropathy and dose adjustment. 27 October 2026 CAPOX (XELOX): dose, schedule and side effects Dose and schedule of CAPOX or XELOX (oxaliplatin 130 and capecitabine 1000 twice daily, days 1 to 14), length of adjuvant treatment, renal adjustment and side effects. 27 October 2026 FOLFIRI regimen: dose, schedule and side effects Dose and schedule of FOLFIRI (irinotecan 180, leucovorin 400, fluorouracil 400 bolus and 2400 as a 46-hour infusion), diarrhoea control, UGT1A1 and dose adjustment.