Short-course radiotherapy versus long-course chemoradiotherapy in total neoadjuvant therapy of rectal cancer – A multicenter analysis of early outcomes and toxicity

Wurschi G, Kesselmeier M, Schneider M, Becker JN, Frerker B, Vorbach SM, Ehret F, Diefenhardt M, Schunn F, von Gruben ME, Büttner M, Hoffmann E, Rühle A, Beier J, Ferdinandus S, Trommer M, Sahin EC, Hlouschek J, Aninditha K, von Ohlen DS, Kaufmann J, Depardon A, Ha HM, Trommer S, Kessler C, Cieslak A, Fabian A, Rißner F, Römer M, Mäurer M, Pietschmann K (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Radiotherapy and Oncology Elsevier

Book Volume: 213

Article Number: 111194

DOI: 10.1016/j.radonc.2025.111194

Abstract

Background and Purpose: Total neoadjuvant therapy (TNT) improves local control and complete response (CR) rates in locally advanced rectal cancer (LARC). CR is associated with favorable local tumor control, allowing non-operative management (NOM). However, it remains unclear whether short-course radiotherapy (SCRT) or long-course chemoradiotherapy (LCRT) is preferable within TNT. Methods: LARC patients undergoing TNT between 2015 and 2024 were included in this retrospective multicenter analysis (DRKS00033000). The primary endpoint was CR. Secondary endpoints comprised NOM rates, toxicity, and tumor control. Multivariable logistic regression modelling was used to assess the influence of LCRT. Results: Of 295 included patients with a median age at diagnosis of 62 (Q1-Q3: 54–68) years and 210 (71.2 %) men, 172 (58.3 %) underwent LCRT. CR was achieved in 46 (37.4 %) SCRT and 96 (55.8 %) LCRT patients. Acute toxicity grade ≥ 3 occurred in 24 (20.5 %) of 117 SCRT and in 62 (36.3 %) of 171 LCRT patients. Within a median follow-up of 19.4 months (SCRT) and 19.6 months (LCRT), 23 (19.8 %) of 116 and 30 (19.4 %) of 155 patients experienced recurrence, respectively. Regression modelling revealed an increased likelihood for CR (adjusted odds ratio: 3.11; 95 % confidence interval: 1.37–7.07) and NOM (4.40; 1.46–13.21) with LCRT, whereas no significant associations of LCRT with acute toxicity (0.90; 0.40–2.02), chronic toxicity (1.16; 0.48–2.78), postoperative complications (0.89; 0.62–1.28) or recurrence (0.81; 0.31–2.16) were observed. Conclusion: LCRT was associated with higher CR and NOM rates. Whether it might be preferred over SCRT for intended NOM remains a relevant question to be answered by ongoing randomized trials.

Authors with CRIS profile

Alina Depardon Department of Radiation Oncology

Involved external institutions

Universitätsklinikum Freiburg Universitätsklinikum Leipzig Universitätsklinikum Köln Universitätsklinikum Essen Klinikum Stuttgart Universitätsklinikum Schleswig-Holstein (UKSH) Universitätsmedizin der Johannes Gutenberg-Universität Mainz Otto-von-Guericke-Universität Magdeburg Universitätsklinikum Halle (Saale) Klinikum rechts der Isar Universitätsklinikum Mannheim / University Medical Centre Mannheim (Universitätsmedizin Mannheim) Universitätsklinikum Jena Friedrich-Schiller-Universität Jena Universitätsklinikum Carl Gustav Carus Dresden Medizinische Hochschule Hannover (MHH) / Hannover Medical School Universitätsmedizin Rostock Medizinische Universität Innsbruck Charité - Universitätsmedizin Berlin Universitätsklinikum Frankfurt am Main (KGU) Universitätsklinikum Heidelberg Universitätsklinikum Hamburg-Eppendorf (UKE) Universitätsklinikum Tübingen

How to cite

APA:

Wurschi, G., Kesselmeier, M., Schneider, M., Becker, J.N., Frerker, B., Vorbach, S.M.,... Pietschmann, K. (2025). Short-course radiotherapy versus long-course chemoradiotherapy in total neoadjuvant therapy of rectal cancer – A multicenter analysis of early outcomes and toxicity. Radiotherapy and Oncology, 213. https://doi.org/10.1016/j.radonc.2025.111194

MLA:

Wurschi, Georg, et al. "Short-course radiotherapy versus long-course chemoradiotherapy in total neoadjuvant therapy of rectal cancer – A multicenter analysis of early outcomes and toxicity." Radiotherapy and Oncology 213 (2025).

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