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Neoadjuvant Chemoradiation Does Not Improve Outcomes for Patients Undergoing Resection for Upper Rectal Cancer: A US
Caroline R Goel1, Christina M Gozza2, Adriana C Gamboa1
1Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
The American Surgeon
|August 28, 2025
Summary
Neoadjuvant chemoradiation (NCRT) for upper rectal cancer did not improve survival or recurrence rates. However, NCRT was linked to a threefold increase in diverting loop ileostomy rates, suggesting it may not be beneficial for this specific cancer location.
Area of Science:
- Surgical Oncology
- Gastrointestinal Oncology
- Radiation Oncology
Background:
- The role of neoadjuvant chemoradiation (NCRT) in treating upper rectal cancer is debated.
- Current treatment guidelines often recommend NCRT for lower rectal cancers, but its efficacy in upper rectal cancers is less clear.
Purpose of the Study:
- To evaluate the association between neoadjuvant chemoradiation (NCRT) and patient outcomes in upper rectal cancer.
- To compare recurrence-free survival (RFS), overall survival (OS), and postoperative complications between patients who received NCRT and those who did not.
Main Methods:
- Retrospective analysis of 193 patients with nonmetastatic upper rectal cancer (≥12 cm from anal verge) treated between 2007-2017.
- Comparison of outcomes between patients who received NCRT (n=93) and those who did not (n=100).
- Primary outcomes included RFS and OS; secondary outcomes included postoperative complications such as anastomotic leak and the need for diverting loop ileostomy (DLI).
Main Results:
- Neoadjuvant chemoradiation (NCRT) was not associated with significant improvements in 3-year recurrence-free survival (80% vs 85%, P=0.34) or overall survival (90% vs 88%, P=0.49).
- R0 resection rates were similar between groups (97% with NCRT vs 99% without NCRT, P=0.27).
- Patients receiving NCRT had a nearly threefold higher rate of diverting loop ileostomy (DLI) creation (82% vs 29%, P<0.001) and similar rates of anastomotic leak (11% in both groups).
Conclusions:
- Neoadjuvant chemoradiation (NCRT) does not appear to improve survival or reduce recurrence rates in patients with nonmetastatic upper rectal cancer.
- The use of NCRT in upper rectal cancer is associated with a significantly higher rate of diverting loop ileostomy (DLI).
- These findings suggest that NCRT may not be a beneficial treatment modality for upper rectal cancer, contrasting its established role in lower rectal cancer.
