Efficacy and Safety of Short-Course Radiotherapy Alone or Combined With Consolidation Chemotherapy Versus Conventional Long-Course Chemoradiotherapy for Locally Advanced Rectal Cancer: A Meta-Analysis of Randomized Controlled Trials

Short-course radiotherapy (SCRT)-based regimens, including SCRT-alone and SCRT-based total neoadjuvant therapy (SCRT-based TNT, defined as SCRT followed by consolidation chemotherapy), have emerged as…

By Wang, Han, Xue +3Journal of gastrointestinal cancerOct 28, 2026

Score█████░░░░░5.1

Key numbers

95% confidence intervals
95% CI
3,061 patients

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Abstract

Objective Short-course radiotherapy (SCRT)-based regimens, including SCRT-alone and SCRT-based total neoadjuvant therapy (SCRT-based TNT, defined as SCRT followed by consolidation chemotherapy), have emerged as alternative neoadjuvant options to long-course chemoradiotherapy (LCCRT) for locally advanced rectal cancer (LARC). This meta-analysis stratified analyses by the type of SCRT regimen and whether LCCRT arms received preoperative consolidation chemotherapy, to systematically compare their efficacy and safety and inform personalized treatment selection. Methods A systematic search of PubMed, Embase, Cochrane Library, and Web of Science identified randomized controlled trials (RCTs) comparing SCRT-based regimens and LCCRT up to November 2025. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Pooled analyses were conducted using Review Manager 5.3, with relative risk (RR) or hazard ratio (HR) and 95% confidence intervals (CIs). Results Nine randomized trials (reported in 16 publications), involving 3,061 patients, were included. In the primary comparison of SCRT-based TNT versus standard LCCRT, the SCRT-based TNT group achieved a significantly higher pathological complete response rate (RR = 1.56, 95% CI: 1.24-1.97, P = 0.0002), whereas tumor downstaging and locoregional failure showed no significant differences from the LCCRT group. The SCRT-based TNT regimen was associated with a significantly higher incidence of grade ≥ 3 acute toxicity (RR = 1.63, 95% CI: 1.14-2.34, P = 0.008), and showed numerical trends toward improved overall survival (HR = 0.99, 95% CI: 0.76-1.28, P = 0.91) and disease-free survival (HR = 1.05, 95% CI: 0.77-1.43, P = 0.77) that did not reach statistical significance. SCRT alone was associated with lower pCR (RR = 0.13, 95% CI: 0.03-0.51, P = 0.003) and downstaging rates (RR = 0.66, 95% CI: 0.56-0.79, P < 0.00001) but a markedly lower incidence of acute toxicity (RR = 0.12, 95% CI: 0.05-0.29, P < 0.00001). An exploratory analysis based on a single small trial found no significant differences between SCRT-based TNT and LCCRT-based TNT across all major endpoints. Pooling all SCRT-based strategies obscured clinically meaningful heterogeneity and yielded no significant differences for any primary endpoint. Conclusions SCRT-based TNT significantly improves pCR compared with standard LCCRT but does not translate into survival benefit, with a numerical increase in locoregional failure. SCRT-alone offers lower acute toxicity but substantially poorer tumor response, warranting use only in selected patients. The comparison between SCRT-based TNT and LCCRT-based TNT remains inconclusive. SCRT-based regimens represent heterogeneous treatment pathways rather than a uniform substitute for LCCRT, requiring individualized clinical decision-making.

Chaoyang Wang, Yaguang Han, Shuxin Xue, Kejia Liu, Zhenlin Zhang, Yong Li

The editor's rubric

Heuristic review

Leverage2 / 5: Reusable within one subfield (a technique, dataset, or protocol a few groups will adopt).; 10% of this desk’s rubric
Magnitude3 / 5: Large gain: roughly 2x, or a clear new state of the art on a hard, unsaturated problem.; 20% of this desk’s rubric
Evidence5 / 5: Definitive: phase 3 randomized evidence on hard endpoints, multi-lab replication, or community verification at scale.; 32% of this desk’s rubric
Novelty2 / 5: A new combination of known ideas.; 8% of this desk’s rubric
Trajectory2 / 5: Some room to improve with obvious engineering.; 5% of this desk’s rubric
Stakes3 / 5: Meaningful benefit to many people within a few years.; 25% of this desk’s rubric

Dimension	Level	Weight	What that level means
Leverage	██░░░2/5	10%	Reusable within one subfield (a technique, dataset, or protocol a few groups will adopt).
Magnitude	███░░3/5	20%	Large gain: roughly 2x, or a clear new state of the art on a hard, unsaturated problem.
Evidence	█████5/5	32%	Definitive: phase 3 randomized evidence on hard endpoints, multi-lab replication, or community verification at scale.
Novelty	██░░░2/5	8%	A new combination of known ideas.
Trajectory	██░░░2/5	5%	Some room to improve with obvious engineering.
Stakes	███░░3/5	25%	Meaningful benefit to many people within a few years.

Editor’s rationale

Heuristic triage from title and abstract text only, not a reading of the paper. Cues found: gains (efficacy); novelty (alternative to status quo); design (randomized, meta-analysis); verification (confidence interval, p-value, error bars); stakes (mortality, major disease, prevention or cure). Red flags: derivative (comparative study); weak evidence (preliminary).

How the score was computed

rank-2026-10-18

Score█████░░░░░5.1

Score = 10 × (80% × adjusted merit / 10 + 10% × attention + 10% × freshness)

Desks place stronger verdicts first, then use this score to order work within the same verdict.

Merit: 6.8 / 10; Weighted rubric, evidence-gated.
Adjusted merit: 5.4 / 10; Shrunk toward the desk prior by editor confidence (50%).
Attention: 0%; Citations, upvotes, points, mentions.
Freshness: 80%; Half-life decay since publication.

Citations0 (reference 20, via openalex, Oct 31, 2026, 06:17 UTC)

The record

Reviewed by heuristic-v10 on Oct 31, 2026, 06:17 UTC. Paper type: clinical.
Categories: Meta-Analysis, Comparative Study, Review, Journal Article, Humans, Rectal Neoplasms, Treatment Outcome, Neoadjuvant Therapy, Randomized Controlled Trials as Topic, Consolidation Chemotherapy
BRIEF, No.4 in the Medicine edition of October 31, 2026.