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

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-10-10 DOI:10.1016/j.radonc.2025.111194

Georg Wurschi , Miriam Kesselmeier , Melanie Schneider , Jan-Niklas Becker , Bernd Frerker , Samuel M. Vorbach , Felix Ehret , Markus Diefenhardt , Fabian Schunn , Maria-Elena von Gruben , Marcel Büttner , Elgin Hoffmann , Alexander Rühle , Josephine Beier , Simone Ferdinandus , Maike Trommer , Ezgi Ceren Sahin , Julian Hlouschek , Kynann Aninditha , Daphne Schepers von Ohlen , Klaus Pietschmann

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引用次数: 0

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.

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短期放疗与长期放化疗在直肠癌全新辅助治疗中的对比——早期结果和毒性的多中心分析。

背景与目的：全面新辅助治疗（TNT）可提高局部晚期直肠癌（LARC）的局部控制率和完全缓解率。CR与有利的局部肿瘤控制相关，允许非手术治疗（NOM）。然而，目前尚不清楚在TNT中，短期放疗（SCRT）还是长期放化疗（LCRT）更可取。方法：2015 - 2024年间接受TNT治疗的LARC患者纳入回顾性多中心分析（DRKS00033000）。主要终点是CR，次要终点包括NOM率、毒性和肿瘤控制。采用多变量logistic回归模型评估LCRT的影响。结果：295例患者诊断时中位年龄为62岁（Q1-Q3: 54-68），男性210例（71.2 %），其中172例（58.3 %）接受了LCRT。46例（37.4% %）SCRT患者和96例（55.8% %）LCRT患者达到CR。117例SCRT患者中有24例（20.5 %）发生急性毒性等级 ≥ 3,171例LCRT患者中有62例（36.3 %）发生急性毒性等级 ≥ 3。在中位随访19.4 个月（SCRT）和19.6 个月（LCRT）中，116例患者中分别有23例（19.8 %）和155例患者中有30例（19.4 %）出现复发。回归模型显示，LCRT增加了CR（校正比值比：3.11；95 %置信区间：1.37-7.07）和NOM（4.40; 1.46-13.21）的可能性，而LCRT与急性毒性（0.90;0.40-2.02）、慢性毒性（1.16;0.48-2.78）、术后并发症（0.89;0.62-1.28）或复发（0.81;0.31-2.16）无显著相关性。结论：LCRT与较高的CR和NOM发生率相关。对于预期的NOM，它是否优于SCRT仍然是一个相关的问题，需要通过正在进行的随机试验来回答。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.