- Design
- Meta-analysis of randomised controlled trials
- Population
- 9 RCTs, 3,061 patients with locally advanced rectal cancer
- Primary outcome
- Pathological complete response, survival, toxicity
- Effect
- pCR RR 1.56 (1.24–1.97); grade ≥3 toxicity RR 1.63 (1.14–2.34); OS HR 0.99 (0.76–1.28)
A meta-analysis of nine randomised trials (3,061 patients) compared short-course radiotherapy-based regimens with long-course chemoradiotherapy for locally advanced rectal cancer, separating short-course radiotherapy alone from short-course radiotherapy followed by consolidation chemotherapy (a total neoadjuvant approach).
Short-course radiotherapy with consolidation chemotherapy raised pathological complete response (RR 1.56) but also grade 3 or higher acute toxicity (RR 1.63), without improving overall survival (HR 0.99) or disease-free survival (HR 1.05), and locoregional failure was numerically higher. Short-course radiotherapy alone had far lower complete response and downstaging but much less toxicity.
The authors stress that these are different treatment pathways, not interchangeable substitutes. A higher complete response rate matters most where organ preservation is the goal; for survival, the regimens look similar.
- Do not treat short-course radiotherapy regimens as one interchangeable option.
- Consider short-course radiotherapy with consolidation chemotherapy where a higher complete response, for example for organ preservation, is the aim.
- Expect more acute toxicity with the total neoadjuvant approach.
- Reserve short-course radiotherapy alone for selected patients, such as the frail.
Why it matters
Complete response and survival point in different directions, so the choice depends on what matters to the patient.
Don't overread it
Pathological complete response is a surrogate; survival did not differ.
The statistics, in plain English
An RR of 1.56 means complete responses were about 56% more frequent. Survival HRs near 1 with intervals spanning it show no detectable difference in living longer.
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