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Esophageal Cancer Research and Treatment / Colorectal Cancer Surgical Treatments / Colorectal and Anal Carcinomas · Journal article
Diseases of the Colon & Rectum · August 14, 2026
Reinforces what was already believed, rather than introducing something new.
This retrospective propensity-matched analysis of 3,442 patients with locally advanced rectal cancer treated with total neoadjuvant therapy found no difference in 48-month overall survival between long and short course radiation (p = 0.397). Long course radiation was associated with higher nodal downstaging (66.5% vs 62.7%, p = 0.023) and a nonsignificant trend toward lower nodal disease, but pathological complete response and tumor downstaging were similar between groups.
Retrospective propensity-matched cohort study. Adults with clinical Stage II or III rectal adenocarcinoma treated with neoadjuvant chemotherapy and radiation followed by radical surgical resection, identified in the National Cancer Database.. Intervention: Long course radiotherapy as a component of total neoadjuvant therapy. Compared with: Short course radiotherapy as a component of total neoadjuvant therapy. n = 3,442. National Cancer Database (United States).
Overall survival at 48 months did not differ between long and short course radiation (log rank p = 0.397) Long course radiotherapy had higher nodal downstaging (66.5% vs 62.7%, p = 0.023) No differences in pathological complete response rate, pathological tumor stage, or tumor downstaging between groups
No information provided on treatment completion rates, toxicity, or quality of life between regimens
These findings support the use of either long or short course radiotherapy regimens as part of total neoadjuvant therapy when planned resection is intended, as both achieve similar overall survival. The higher nodal downstaging with long course radiation lacks established clinical significance and does not translate to survival benefit in this analysis.
Retrospective propensity-matched cohort study showing no difference in overall survival between radiation regimens in total neoadjuvant therapy for rectal cancer, confirming equipoise between approaches already in clinical use.
As stated by the source record.
Quoted from the source exactly as published.
These findings support the use of either long or short course radiotherapy regimens as part of total neoadjuvant therapy when planned resection is intended, as both achieve similar overall survival. The higher nodal downstaging with long course radiation lacks established clinical significance and does not translate to survival benefit in this analysis.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
BACKGROUND: Locally advanced rectal cancer is treated with total neoadjuvant therapy which consists of neoadjuvant chemotherapy, radiation, and surgery. The comparative efficacy of long and short course radiotherapy within total neoadjuvant therapy remains uncertain. OBJECTIVE: Compare overall survival and pathological outcomes between patients treated with long or short course radiation as components of total neoadjuvant therapy. DESIGN: Retrospective cohort study. SETTINGS: National Cancer Database, 2018 to 2023. PATIENTS: Adults with clinical Stage II or III rectal adenocarcinoma treated with neoadjuvant chemotherapy and radiation followed by radical surgical resection. MAIN OUTCOME MEASURES: Overall survival and pathological outcomes in a propensity score matched cohort comparing long and short course radiation. RESULTS: A total of 12,462 patients met inclusion criteria; 10,740 (86.2%) received long course radiation and 1,722 (13.8%) received short course radiation. After 1:1 propensity score matching, 1,721 per group were identified. Overall survival at 48 months did not differ (log rank p = 0.397). There were no differences in pathological complete response rate, pathological tumor stage, tumor downstaging, or pathological nodal stage. The long course radiotherapy group had higher nodal downstaging (66.5 vs 62.7%, p = 0.023) and a nonsignificant trend towards lower nodal disease (N0 73.9 vs 70.7%, N1 21.5 vs 23.3%, and N2 4.6 vs 6.0%, respectively, p = 0.062). LIMITATIONS: Residual confounding from unmeasured clinical and treatment details is possible. This cohort was restricted to patients who underwent resection. CONCLUSIONS: Among locally advanced rectal cancer patients treated with total neoadjuvant therapy and radical resection, long and short course radiotherapy had similar overall survival, but long course radiotherapy patients had higher rates of nodal downstaging. These findings support the use of either long or short course radiotherapy regimens when planned resection is intended, but the clinical significance of differences in nodal downstaging remain uncertain. See Video Abstract.
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