Desley van Zoggel

Chapter 1 14 showing that local response of the tumour may also be amplified with this approach.21 The RAPIDO study, which randomized between short course radiotherapy followed by chemotherapy versus chemoradiotherapy, both followed by surgery, confirmed the increased local response rates, and also a reduction of development of metastases.22 Both studies did not show a survival benefit. The recent publication of the PRODIGE 23 study confirmed prior findings and noted a trend towards improved overall survival.23 All these studies showed that this total neoadjuvant approach was feasible in locally advanced primary rectal cancer without significant increase of morbidity, and might lead to an improved oncological outcome. In this thesis the principle of introducing total neoadjuvant treatment in the management of LRRC is investigated.