Short-Term Results of the SONCAR Study: Optimized Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Patients

Rongxin Zhang; Fulong Wang; Xinhua Jiang; Hao Wang; Weili Zhang; Zhifan Zeng; Yuanhong Gao; Xiaojun Wu; Gong Chen; Liren Li; Peirong Ding; Shixun Lu; Jian Zhang; Min Liu; Qiaoxuan Wang; Weiwei Xiao; Zhizhong Pan; Desen Wan; Zhen-hai Lu

doi:10.1002/mco2.70222

MedComm ›› 2025, Vol. 6 ›› Issue (8) : e70222 DOI: 10.1002/mco2.70222

ORIGINAL ARTICLE

Short-Term Results of the SONCAR Study: Optimized Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Patients

Rongxin Zhang ¹^,²^,³
, Fulong Wang ¹^,²^,³
, Xinhua Jiang ²^,³^,⁴
, Hao Wang ¹^,²^,³
, Weili Zhang ¹^,²^,³
, Zhifan Zeng ²^,³^,⁵
, Yuanhong Gao ²^,³^,⁵
, Xiaojun Wu ¹^,²^,³
, Gong Chen ¹^,²^,³
, Liren Li ¹^,²^,³
, Peirong Ding ¹^,²^,³
, Shixun Lu ²^,³^,⁶
, Jian Zhang ⁷
, Min Liu ²^,³^,⁸
, Qiaoxuan Wang ²^,³^,⁵
, Weiwei Xiao ²^,³^,⁵
, Zhizhong Pan ¹^,²^,³
, Desen Wan ¹^,²^,³
, Zhen-hai Lu ¹^,²^,³

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Abstract

This research endeavored to ascertain whether four cycles of oxaliplatin in conjunction with standard radiation (oxaliplatin-CRT) could enhance overall survival when compared with standard neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). A Phase III randomized trial (SONCAR Trial, NCT02031939) was conducted in China, involving patients diagnosed with clinical T3-4 and/or N+ rectal cancer. Patients were randomly allocated to the experimental arm (receiving pelvic radiation (50 Gy/25 fractions) in conjunction with oxaliplatin and capecitabine) or the control arm (pelvic radiation in conjunction with capecitabine alone). The main endpoint was a 5-year OS, while the secondary objectives encompassed pathological complete response (pCR), 3-year disease-free survival, and surgical complications. A total of 536 patients were assessable. The rate of pCR was notably higher in the experimental group (31.9%) than in the control group (21.5%) (p = 0.008). The clinical complete response (cCR) rate was also higher in the experimental group (p = 0.024). Among patients with tumors located within 5 cm of the anal verge, the experimental group exhibited a significantly greater tumor regression, with rates of 33.8% compared to 21.6% in the control group (p = 0.024). In summary, oxaliplatin-CRT significantly augmented the tumor response in LARC patients with manageable toxicity.

Keywords

locally advanced rectal cancer / neoadjuvant chemoradiotherapy / oxaliplatin / toxicity

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Rongxin Zhang, Fulong Wang, Xinhua Jiang, Hao Wang, Weili Zhang, Zhifan Zeng, Yuanhong Gao, Xiaojun Wu, Gong Chen, Liren Li, Peirong Ding, Shixun Lu, Jian Zhang, Min Liu, Qiaoxuan Wang, Weiwei Xiao, Zhizhong Pan, Desen Wan, Zhen-hai Lu. Short-Term Results of the SONCAR Study: Optimized Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Patients. MedComm, 2025, 6(8): e70222 DOI:10.1002/mco2.70222

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