2181 - Three Treatment Approaches for Locally Advanced Rectal Cancer: Total Neoadjuvant Therapy, Preoperative Chemoradiotherapy, and Postoperative Chemoradiotherapy - A Systematic Review and Network Meta-Analysis
Presenter(s)
X. Qixinya1, Q. Liu1, Y. Wang1, and N. Li2; 1Peking Union Medical College; The Cancer Hospital of the Chinese Academy of Medical Sciences, Beijing, chaoyang, China, 2State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Purpose/Objective(s): Rectal cancer is a highly prevalent malignancy globally. For locally advanced rectal cancer, preoperative chemoradiotherapy has become the standard treatment regimen, while total neoadjuvant therapy (TNT) has emerged as a focal point of research in recent years. Although numerous randomized controlled trials have demonstrated the superiority of total neoadjuvant therapy for local control, its impact on overall survival compared with conventional preoperative chemoradiotherapy and postoperative chemoradiotherapy remains unclear and requires further evidence-based studies. Therefore, this study aims to comprehensively evaluate the efficacy of these three treatment regimens for locally advanced rectal cancer.
Materials/Methods: We conducted a comprehensive search of databases including Embase, PubMed, The Cochrane Library, and additional sources for randomized controlled trials (RCTs) involving adults aged =18 years, regardless of gender, who were diagnosed with locally advanced rectal cancer (LARC) and received total neoadjuvant therapy (TNT), preoperative chemoradiotherapy, or postoperative chemoradiotherapy as their treatment regimen, up to October 2025. The primary endpoints of the study were 3-year disease-free survival (DFS) and overall survival (OS). The methodological quality of the included studies was evaluated using the Cochrane risk of bias tool, and the network meta-analysis was conducted in STATA 18.
Results: A total of nine randomized controlled trials involving 5,410 patients were included in the analysis. The results of the network meta-analysis indicated that total neoadjuvant therapy (TNT) significantly improved 3-year overall survival compared to preoperative or postoperative chemoradiotherapy (TNT vs. Pre-CRT: RR, 1.64; 95% CI, 1.24–2.18. TNT vs. Post-CRT: RR, 2.41; 95% CI, 1.09–5.30). No statistically significant differences in 3-year overall survival were observed between preoperative and postoperative chemoradiotherapy, nor in 3-year disease-free survival (DFS) among the three treatment modalities.
Conclusion: In the treatment of locally advanced rectal cancer, total neoadjuvant therapy (TNT) demonstrates the most pronounced benefit in improving 3-year overall survival. Therefore, it should be considered the treatment of choice for this patient population.