Short versus long course radiation in total neoadjuvant therapy for locally advanced rectal cancer yields similar overall survival outcomes.

• Overall survival at 48 months is comparable between long course (86.2%) and short course (13.8%) radiation (p = 0.397).
• Long course radiotherapy shows higher nodal downstaging rates (66.5% vs 62.7%, p = 0.023).

Consider both regimens for treatment planning since survival outcomes are similar, though nodal downstaging may vary.

• No significant differences noted in complete response rates or tumor staging.