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Session:: ePosters-Mon330-M1: Rectal Cancer

EP1012 - Short vs Long-Course Radiation Therapy in Locally Advanced Rectal Cancer: Utilization Trends, Survival, and Morbidity

Monday, May 11, 2026
4:30 PM - 4:35 PM ET

    ePoster Presenter(s)

  • Rachel Jensen, MD MHPE

    Colon and Rectal Surgery Fellow
    University of Minnesota
    University of Minnesota
    Minneapolis, MN, United States

    Disclosure information not submitted.

    • Author(s)

  • Keegan Guidolin, MD, PhD

    Clinical Fellow, Colon & Rectal Surgery
    University of Minnesota
    University of Minnesota
    Minneapolis, MN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Julia Frebault, MD (she/her/hers)

    General Surgery Research Resident
    University of Minnesota
    University of Minnesota
    Minneapolis, MN, United States

    Disclosure information not submitted.

  • SM

    Sarah Mott, MS

    Biostatistician
    University of Iowa Holden Comprehensive Cancer Center
    Iowa City, Iowa, United States

    Disclosure information not submitted.

  • DD

    Dayssy Diaz, M.D, MS

    Professor
    University of Minnesota
    Minneapolis, Minnesota, United States

    Disclosure information not submitted.

  • CT

    Catherine Tran, MD

    Colon & Rectal Surgeon
    Colon & Rectal Surgery Associates
    Minneapolis, Minnesota, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Paolo Goffredo, MD (he/him/his)

    Assistant Professor
    University of Minnesota
    Minneapolis, MN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Keegan Guidolin, MD, PhD: This individual has no financial relationships with ineligible companies.
Paolo Goffredo, MD: This individual has no financial relationships with ineligible companies.
Purpose/Background: Current guidelines recommend total neoadjuvant therapy (TNT) for rectal cancer, which traditionally utilized long-course radiation therapy (LCRT) given over a 5-6 week period. More recently, there has been increased interest in short course radiation therapy (SCRT) as a more time-efficient alternative. However, there is a paucity of data on patterns of use of SCRT and its outcomes. This study sought to evaluate utilization trends and outcomes of LCRT vs SCRT.

Methods/Interventions: Adults with clinical stage II or III rectal adenocarcinoma diagnosed in 2018-2021 and managed with TNT and surgery were identified in the National Cancer Database. Multivariable logistic and Cox regression was used to evaluate the effect of patient, clinicopathologic, and treatment characteristics on use of SCRT, 3-year overall survival (OS), and morbidity as a composite outcome comprised of 30-day readmission, 30 or 90 day mortality, or length of stay >7 days.

Results/Outcomes: Among 6,089 patients (87% age < 70, 62% male, 85% white), 12% received SCRT and 88% received LCRT. On multivariable analysis, when compared to academic settings, treatment in community or integrated settings was associated with decreased odds of use of SCRT (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.23-0.61 and OR 0.44, 95% CI 0.37-0.53, respectively). Treatment in Mountain and Pacific regions was associated with increased odds of use compared to the Central region (OR 1.38, 95% CI 1.09-1.75). Traveling >30 miles to the hospital was also associated with increased odds of use of SCRT compared to a shorter distance (OR 1.45, 95% CI 1.20-1.76); Table 1. 3-year OS post-surgery for patients receiving SCRT and LCRT was 91% (95% CI 87-94%) and 88% (95% CI 87-89%), respectively. On multivariable analysis, there was no statistically significant difference in 3-year OS between the two radiotherapy regimens (hazard ratio 0.89, 95% CI 0.60-1.33; Table 2). Morbidity was higher for the SCRT group (26% v 20%, p< 0.01).

Conclusion/Discussion: In this contemporary cohort of United States (US)-based patients undergoing TNT and surgery for locally advanced rectal cancer, SCRT was used much less frequently than LCRT. Factors associated with higher use of SCRT included treatment in an academic setting and in the Mountain and Pacific regions of the US, suggesting institutional and regional differences in comfort or access to this modality. The data also highlight key logistical considerations in patient selection such as driving distance for treatment. While rates of complete clinical response could not be evaluated in this cohort, SCRT demonstrated similar survival but higher morbidity than LCRT, suggesting that SCRT should be used selectively.

Utilization Trends of SCRT
Multivariate analysis demonstrating odds of use of SCRT

Overall Survival
Multivariate analysis demonstrating 3-year overall survival