Long-Term Outcomes of Long-Course Chemoradiotherapy vs. Short-Course Radiotherapy Followed by Consolidation Chemotherapy in Rectal Cancer.

PURPOSE: Previous studies have demonstrated that short-course radiotherapy (SCRT), followed by consolidation chemotherapy (CCT), produces oncologic outcomes comparable to those of long-course chemoradiotherapy (LCRT). However, more recent long-term data have raised concerns regarding the durability of these benefits. This study aimed to assess the long-term surgical and oncologic outcomes of SCRT with CCT vs. LCRT, using data from the ESCORT trial.

MATERIALS AND

METHODS

This comparative study included 62 patients with locally advanced rectal cancer. Patients in the SCRT group (n=27) were prospectively enrolled in the ESCORT trial (NCT03676517), a single-arm phase II study conducted from 2018 to 2020. They received five daily fractions of 5 Gy, followed by two cycles of XELOX, and surgery after 4 weeks. A matched cohort of 35 patients who underwent LCRT during the same period was retrospectively identified from institutional records.

RESULTS

With a median follow-up of 4.75 years for the SCRT group and 4.94 years for the LCRT group, the 5-year overall survival rates were similar between the groups (SCRT: 100% vs. LCRT: 97.1%, p=0.382). The 5-year disease-free survival (DFS) rates were 83.6% for SCRT and 70.3% for LCRT (p=0.237). In multivariable analysis, SCRT was not associated with inferior DFS (hazard ratio, 0.53; 95% confidence interval, 0.14-2.04). Delayed anastomosis-related complications occurred at similar rates (18.5% vs. 20.0%; p=0.884).

CONCLUSION

SCRT with CCT demonstrated long-term oncologic outcomes and surgical safety comparable to those of LCRT, supporting its role as a viable alternative, particularly in resource-constrained healthcare settings.