Retrospective cohort study of neoadjuvant radiotherapy versus upfront surgery for resectable locally advanced rectal cancer

Guidelines for resectable locally advanced rectal cancer (LARC) advocate for neoadjuvant radiotherapy (NRT) followed by surgery as the standard approach. A cohort study including 4099 LARC patients from nationwide registries in Taiwan found that compared with upfront surgery, NRT before surgery was associated with improved overall survival, however, at the cost of increased risk of diverting stoma nonreversal. Subgroup analyses found overall survival benefit with NRT for middle or lower LARC but not upper LARC. The authors conclude that the trade-off between NRT use and diverting stoma nonreversal may not be justified for upper rectal cancer.