Key result
Preoperative radiotherapy significantly improved overall survival in locally advanced rectal cancer patients with a tumor size > 5 cm (HR 0.45), but provided no survival benefit for those with tumors ≤ 5 cm.
Why the study?
The study was conducted to determine whether tumor size could serve as a decision-making factor in the management of preoperative radiotherapy for patients with locally advanced rectal cancer.
Does preoperative radiotherapy improve overall survival in patients with locally advanced rectal cancer based on tumor size?
Cohort (n=1,402)
Does preoperative radiotherapy improve overall survival in patients with locally advanced rectal cancer based on tumor size?
Preoperative radiotherapy provides a significant overall survival benefit for locally advanced rectal cancer patients with tumors >5 cm, but may not be necessary or could be detrimental for those with tumors <=5 cm lacking other risk factors.
Answers are grounded in this paper and cite their sources.
May guide tumor size-based preoperative RT decisions in LARC; hypothesis-generating and requires prospective validation.
BACKGROUND: To identify tumor size could be taken as a decision-making factor in the management of preoperative radiotherapy (RT) for patients with locally advanced rectal cancer (LARC). METHODS: In this study, patients diagnosed with rectal adenocarcinoma and staged at II/III from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2014 were included. Kaplan-Meier curve was conducted to investigate the overall survival (OS) between subgroups with different tumor sizes and the relationship between the tumor size and the efficacy of preoperative RT. RESULTS: There were 1402 patients eligible for this study, of whom 1105 (78.8%) received preoperative radiotherapy (RT + S group) and 297 (21.2%) underwent surgery alone (S group). The median OS was comparable between groups of RT + S and S before and after propensity score matching (both P > 0.05), but tumor size was a robust independent risk factor of OS (P < 0.05). 5 cm was then identified to the optimal cut-off value of tumor size using the minimum P value. Further analysis showed that preoperative RT could only benefit those with tumor size > 5 cm (P < 0.05); while on the contrary, it would hamper the OS of those with tumor size ≤ 5 cm and no OS risk factors (P > 0.05). CONCLUSION: Data from this retrospective analysis of patients with LARC seems to indicate that tumor size might play a role in the decision-making process for (tumors > 5 cm) or against (tumors ≤ 5 cm) preoperative radiotherapy.
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Zhong et al. (2025) conducted a cohort in Locally advanced rectal cancer (n=1,402). Preoperative radiotherapy vs. Surgery alone was evaluated on Overall survival (HR 0.82, 95% CI 0.57-1.17, p=0.270). Preoperative radiotherapy significantly improved overall survival in locally advanced rectal cancer patients with a tumor size > 5 cm (HR 0.45), but provided no survival benefit for those with tumors ≤ 5 cm.
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