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Neoadjuvant Radiation Versus Upfront Surgery for Upper Rectal Cancer: A Systematic Review and Meta-Analysis of the
Ahmed A Eltahir1, Oluseye K Oduyale1, Vikram Pothuri2
1Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
The Journal of Surgical Research
|August 10, 2026
Summary
Neoadjuvant radiation therapy (NRT) offers no significant survival benefit for upper rectal cancer but effectively reduces local recurrence risk. Its use should be selective, especially in high-risk cases, balancing benefits against potential side effects.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Neoadjuvant radiation therapy (NRT) is standard for lower/middle rectal cancers.
- Its role in upper rectal cancer is debated due to conflicting evidence.
- This study re-evaluates NRT versus upfront surgery for upper rectal cancer.
Purpose of the Study:
- To systematically review and meta-analyze studies comparing NRT and upfront surgery for upper rectal cancer.
- To assess the impact of NRT on overall survival (OS) and local recurrence (LR).
Main Methods:
- Systematic search of major databases (PubMed, Embase, etc.) for studies from 2002 onwards.
- Inclusion of randomized controlled trials and observational studies.
- Meta-analysis of primary outcomes: OS and LR.
Main Results:
- Thirteen studies (3 RCTs, 10 observational) were included.
- NRT showed no significant improvement in OS (RR 0.92, 95% CI 0.83-1.02).
- NRT significantly reduced LR risk (RR 0.63, 95% CI 0.43-0.95).
Conclusions:
- NRT does not improve OS in upper rectal cancer but reduces LR.
- Selective NRT use is suggested for higher-risk upper rectal cancers.
- Consideration of adverse effects and anatomical definition challenges is crucial.
