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Review
. 2025 May 1:19:1567818.
doi: 10.3389/or.2025.1567818. eCollection 2025.

Efficacies of radiotherapy in rectal cancer patients treated with total mesorectal excision or other types of surgery: an updated meta-analysis

Wenshu Wang #  1 , Runyuan Zhao #  2 , Xi Liang  1 , Manjun Liu  1 , Haiyan Bai  1 , Jianli Ge  1 , Binxi Yao  1 , Zheng Zhi  1 , Jianming He  1   3
Affiliations
Review

Efficacies of radiotherapy in rectal cancer patients treated with total mesorectal excision or other types of surgery: an updated meta-analysis

Wenshu Wang et al. Oncol Rev. .

Abstract

Background: An updated meta-analysis was conducted to evaluate the efficacy of radiotherapy in rectal cancer patients treated with total mesorectal excision (TME) or other types of surgery (non-TME-only).

Methods: The PubMed, Cochrane Library, and CNKI databases were searched. Data on overall survival (OS) were extracted.

Results: Hazard ratios (HRs) for OS associated with preoperative radiotherapy, preoperative long-course concurrent chemoradiotherapy (LCCRT), preoperative radiotherapy alone, and postoperative radiotherapy in patients treated with TME were 1.02 [95% CI: 0.92-1.14, P = 0.65], 1.04 [95% CI: 0.93-1.16, P = 0.47], 0.87 [95% CI: 0.61-1.25, P = 0.46], and 1.18 [95% CI: 0.91-1.52, P = 0.20], respectively. HRs for OS associated with preoperative radiotherapy, preoperative LCCRT, preoperative radiotherapy alone, preoperative long-course RT (LCRT), and preoperative short-course radiotherapy (SCRT) in patients treated with non-TME-only surgery were 0.85 [95% CI: 0.79-0.90, P < 0.00001], 0.77 [95% CI: 0.63-0.94, P = 0.009], 0.86 [95% CI: 0.80-0.92, P < 0.0001], 0.83 [95% CI: 0.73-0.95, P = 0.005], and 0.84 [95% CI: 0.77-0.91, P= <0.0001], respectively. The HR for postoperative radiotherapy in patients treated with non-TME-only surgery was 1.08 [95% CI: 0.84-1.39, P = 0.57].

Conclusion: Preoperative radiotherapy, regardless of the regimen, improves the OS in patients treated with non-TME-only surgery, but not in those treated with TME. Postoperative radiotherapy does not improve OS.

Advances in knowledge: This meta-analysis will serve as a reference for decision-making in multidisciplinary approaches for rectal cancer patients.

Keywords: TME; concurrent chemoradiotherapy; radiotherapy; rectal cancer; surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Meta-analysis literature search flow chart.
FIGURE 2
FIGURE 2
OR for anal sphincter preservation rate (A). OR for LR rate (B). HR for LR-free survival rate (C).
FIGURE 3
FIGURE 3
Impact of preoperative and postoperative RT on LR of patients treated with TME.
FIGURE 4
FIGURE 4
Impact of preoperative and postoperative RT on LR of patients treated with non-TME.
FIGURE 5
FIGURE 5
Pooled HRs for the survival rate in patients treated with RT (A). Pooled HRs for DFS in patients treated with RT (B).
FIGURE 6
FIGURE 6
Impact of preoperative RT on OS (A). Impact of postoperative RT on OS (B).
FIGURE 7
FIGURE 7
Impact of preoperative CRT on OS (A). Impact of postoperative CRT on OS (B).
FIGURE 8
FIGURE 8
Impact of preoperative LCRT on OS (A). Impact of postoperative LCRT on OS (B). Impact of SCRT on OS (C).
FIGURE 9
FIGURE 9
Impact of preoperative RT on OS of patients treated with TME (A). Impacts of preoperative CRT and preoperative RT-alone on OS in patients treated with TME (B). Impact of postoperative RT on OS in patients treated with TME (C).
FIGURE 10
FIGURE 10
Impacts of preoperative CRT and preoperative RT-alone on OS in patients treated with non-TME sugery (A). Impacts of preoperative LCRT and preoperative SCRT on OS in patients treated with non-TME sugery (B).
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