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In a multicenter, randomized trial, researchers compared neoadjuvant FOLFOX chemotherapy (with chemoradiotherapy used only if the tumor did not decrease in size or if FOLFOX was discontinued due to side effects) to standard chemoradiotherapy for locally advanced rectal cancer. The study included 1,128 patients eligible for sphincter-sparing surgery. The primary endpoint of disease-free survival showed that FOLFOX was non-inferior to chemoradiotherapy (hazard ratio 0.92; 90.2% CI, 0.74 to 1.14). Secondary endpoints, including overall survival and local recurrence, were similar between the two groups. Five-year disease-free survival rates were 80.8% in the FOLFOX group and 78.6% in the chemoradiotherapy group. These findings suggest that preoperative FOLFOX chemotherapy can be considered as an alternative to chemoradiotherapy in this patient population.
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