Clinical Scorecard: Efficacy Comparison of Neoadjuvant Short-Course and Long-Course Radiotherapy Regimens With or Without Immunotherapy for Locally Advanced pMMR Rectal Cancer: A Systematic Review and Network Meta-Analysis

At a Glance

Key Highlights

• SCRT shows non-inferior pCR rates compared to LCRT with potential for higher acute toxicity.
• Total neoadjuvant therapy (TNT) is increasingly used to maximize tumor regression and organ preservation.
• Combination of PD-1 inhibitors with radiotherapy significantly improves pCR rates in pMMR cohorts.

Guideline-Based Recommendations

Diagnosis

• Diagnosis of locally advanced rectal cancer should include assessment of mismatch repair status.

Management

• Consider neoadjuvant SCRT or LCRT with or without immunotherapy based on patient-specific factors.

Monitoring & Follow-up

• Monitor for treatment-related adverse events, particularly grade ≥ 3 toxicities.

Risks

• Be aware of the potential for higher acute grade 3–4 toxicity with SCRT compared to LCRT.

Patient & Prescribing Data

Patients with newly diagnosed, non-metastatic, locally advanced pMMR rectal adenocarcinoma.

Incorporate immunotherapy with radiotherapy to enhance treatment efficacy and improve pCR rates.

Clinical Best Practices

• Utilize a multimodal approach for managing locally advanced rectal cancer.
• Personalize therapy based on biological stratification, particularly mismatch repair status.
• Adopt a Watch-and-Wait strategy for patients achieving clinical complete response.

References

• Systematic Review and Network Meta-Analysis Protocol