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Neoadjuvant Chemotherapy With/Without Radiotherapy for Locally Advanced Rectal Cancer: A Nationwide Retrospective

Tao-Wei Ke1,2, Sheng-Chi Chang1, Yu-Min Liao3

  • 1Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, R.O.C.

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|November 29, 2023
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Summary

For locally advanced rectal cancer patients receiving neoadjuvant systemic therapy, adding neoadjuvant chemoradiotherapy (nCCRT) did not significantly improve long-term survival compared to neoadjuvant chemotherapy without radiotherapy (nCT). Further research is warranted.

Keywords:
Neoadjuvant chemotherapyradiotherapyrectal cancer

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Area of Science:

  • Oncology
  • Gastroenterology
  • Clinical Research

Background:

  • Neoadjuvant radiotherapy's role in locally advanced rectal cancer (LARC) post-neoadjuvant systemic therapy is debated.
  • Current management strategies for LARC require ongoing evaluation.

Purpose of the Study:

  • To investigate the impact of neoadjuvant chemoradiotherapy (nCCRT) versus neoadjuvant chemotherapy without radiotherapy (nCT) on survival outcomes in LARC patients.
  • To assess the long-term clinical efficacy of adding radiotherapy to neoadjuvant systemic therapy for LARC.

Main Methods:

  • Retrospective cohort study using Taiwan Cancer Registry data (2011-2020).
  • Propensity score weighting (PSW) applied to balance confounders between nCCRT and nCT groups.
  • Comparison of overall survival using hazard ratios (HR).

Main Results:

  • Analysis included 2,298 LARC patients.
  • No statistically significant difference in overall survival between nCCRT and nCT groups (PSW-adjusted HR: 0.72; p=0.40).
  • Consistent findings across other long-term outcomes and supplementary analyses.

Conclusions:

  • In LARC patients who received neoadjuvant systemic therapy, adding radiotherapy did not significantly improve long-term clinical outcomes.
  • The findings suggest that neoadjuvant chemotherapy alone may be a viable option for select LARC patients.