Short-course radiotherapy may be a stronger immunotherapy partner in rectal cancer
Recent trials report 40–61% pathologic complete response with short-course radiotherapy plus immunotherapy, but mature comparative outcomes remain unavailable.
Recent trials report 40–61% pathologic complete response with short-course radiotherapy plus immunotherapy, but mature comparative outcomes remain unavailable.
Total neoadjuvant therapy is now central to high-risk rectal cancer and organ preservation
Larger irradiated bowel volumes predicted acute diarrhea after both short-course total neoadjuvant treatment and chemoradiation, although discrimination was modest.
ERI-guided escalation to 60.1 Gy produced a 21.9% complete response rate in patients predicted to respond poorly.
Mean pelvic marrow dose above approximately 24 Gy and V40 above 13% identified higher hematologic toxicity risk during rectal chemoradiotherapy.
Five-year overall survival was 78.1% with short-course total neoadjuvant therapy versus 69.7% with long-course chemoradiotherapy.
No positive lymph nodes were found in ypT0–1 tumours after immunotherapy-based TNT, supporting further study of local excision.
Doublet total neoadjuvant therapy improved three-year disease-free survival, metastasis-free survival, and pathological complete response compared with conventional chemoradiotherapy.
No individual clinical, imaging, blood, or molecular marker reliably predicted pathological complete response, while integrated multimodal models showed greater potential.
Adding CTV radiomics increased internal AUROC from 0.507 to 0.754 for predicting poor response to rectal chemoradiotherapy.
A 56 Gy simultaneous integrated boost improved nine-year survival and disease control compared with standard 50 Gy chemoradiotherapy.
Quantitative T1 relaxation time distinguished complete from incomplete rectal cancer response six weeks after neoadjuvant treatment with an area under the curve of 0.94.
BED >37.5 Gy improved symptomatic control, while 6-month local control remained 46% in frail, elderly, or metastatic rectal cancer.
Dutch radiation oncologists reported substantial variation in dose, delineation, and follow-up for unresectable locally recurrent rectal cancer.
ESTRO–ASTRO guidance supports selected rectal cancer reirradiation using 30–40 Gy regimens, cumulative dose assessment, inverse planning and daily volumetric imaging.