Short-course and long-course radiation give similar survival in rectal cancer

Short-course and long-course radiation led to similar 4-year overall survival in locally advanced rectal cancer treated with total neoadjuvant therapy and surgery.

• Among 3,442 matched patients, 4-year overall survival did not differ between the two radiation groups.
• Long-course radiation gave more nodal downstaging: 66.5% vs 62.7%, a statistically significant difference.
• Pathological complete response rates were the same in both groups.

Either radiation schedule can be used when resection is planned. The nodal downstaging difference is real but its clinical meaning is still unclear, so it should not drive the choice of schedule yet.