Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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.

PubMed Disclaimer

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).
See this image and copyright information in PMC

References

    1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a Cancer J clinicians (2024) 74(3):229–63. 10.3322/caac.21834 - DOI - PubMed
    1. He J, Shin H, Wei X, Kadegowda AKG, Chen R, Xie SK. NPC1L1 knockout protects against colitis-associated tumorigenesis in mice. BMC Cancer (2015) 15:189. 10.1186/s12885-015-1230-0 - DOI - PMC - PubMed
    1. Huang J, Li H, Wang X, Liang X, Zhao T, Hu J, et al. Impacts of ezetimibe on risks of various types of cancers: a meta-analysis and systematic review. Eur J Cancer Prev (2023) 32(1):89–97. 10.1097/CEJ.0000000000000750 - DOI - PubMed
    1. Stockholm Rectal Cancer Study Group. Preoperative short-term radiation therapy in operable rectal carcinoma: a prospective randomized trial. Cancer. (1990) 66(1):49–55. 10.1002/1097-0142(19900701)66.1<4910.1002/1097-0142(19900701)66:1<49::aid-cncr2820660111>3.0.co;2-1aid-cncr2820660111>3.0.co - DOI - PubMed
    1. Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Medical Research Council Rectal Cancer Working Party. Lancet (London, England) (1996) 348(9042):1605–10. 10.1016/s0140-6736(96)05348-2 - DOI - PubMed

LinkOut - more resources