Long T, Gao H, He WQ, Xiao WW, Wang XC. High-dose vs standard radiotherapy in rectal cancer: Effects on tumour response, toxicity, and organ preservation. World J Gastrointest Oncol 2026; 18(8): 120904 [DOI: 10.4251/wjgo.120904]
Corresponding Author of This Article
Xi-Cheng Wang, Professor, Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19 Nonglinxia Road, Yuexiu District, Guangzhou 510080, Guangdong Province, China. 13902400598@126.com
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Oncology
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Long T, Gao H, He WQ, Xiao WW, Wang XC. High-dose vs standard radiotherapy in rectal cancer: Effects on tumour response, toxicity, and organ preservation. World J Gastrointest Oncol 2026; 18(8): 120904 [DOI: 10.4251/wjgo.120904]
World J Gastrointest Oncol. Aug 15, 2026; 18(8): 120904 Published online Aug 15, 2026. doi: 10.4251/wjgo.120904
High-dose vs standard radiotherapy in rectal cancer: Effects on tumour response, toxicity, and organ preservation
Ting Long, Han Gao, Wan-Qi He, Wei-Wei Xiao, Xi-Cheng Wang
Ting Long, Han Gao, Xi-Cheng Wang, Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong Province, China
Wan-Qi He, Department of Ultrasound, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong Province, China
Wei-Wei Xiao, The State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong Province, China
Co-corresponding authors: Wei-Wei Xiao and Xi-Cheng Wang.
Author contributions: Long T performed the research, analyzed the data, wrote the manuscript; Long T, Gao H and He WQ collected the data; Long T, Xiao WW and Wang XC designed the research study; Xiao WW and Wang XC supervised the study, revised the manuscript as co-corresponding authors; all authors have read and approved the final manuscript.
AI contribution statement: AI-assisted tools (e.g., ChatGPT) were used during the preparation of the answering-reviewers to improve language clarity and readability. All responses to the reviewers were independently developed by the authors, and the scientific content and interpretations were fully verified and approved by the authors. No AI tool was used in the writing of the main manuscript. No AI tool was involved in the design of the study, data analysis, or interpretation of results. No images or figures in the manuscript were generated by AI.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Xi-Cheng Wang, Professor, Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19 Nonglinxia Road, Yuexiu District, Guangzhou 510080, Guangdong Province, China. 13902400598@126.com
Received: March 11, 2026 Revised: April 8, 2026 Accepted: June 2, 2026 Published online: August 15, 2026 Processing time: 149 Days and 21.2 Hours
Abstract
BACKGROUND
The impact of high-dose radiotherapy (HDRT) on improving clinical complete response (cCR) and organ preservation in rectal cancer remains uncertain.
AIM
To evaluate the efficacy and safety of HDRT (> 54 Gy) compared with standard-dose radiotherapy (45-54 Gy) in patients with clinically staged I-III rectal cancer.
METHODS
We systematically searched PubMed, EMBASE, MEDLINE (via Web of Science), and the Cochrane Library for randomized controlled trials published between January 1, 2014, and November 11, 2024. The primary outcome was cCR; secondary outcomes included pathological complete response, tumour regression grade (TRG) 1-2, organ preservation, grade ≥ 3 toxicity, overall survival, disease-free survival, local recurrence, and distant metastasis.
RESULTS
Seven randomised controlled trials involving 1056 patients were analysed. An improvement in cCR was observed with HDRT (> 54 Gy) compared with standard-dose radiotherapy (45-54 Gy) [risk ratios (RR) = 1.34, 95%CI: 1.00-1.80; P = 0.05]. HDRT showed no significant advantage in pathological complete response (RR = 1.07, 95%CI: 0.77-1.50) but enhanced TRG 1-2 responses (RR = 1.52, 95%CI: 1.16-1.99; P = 0.002). There were no significant differences in rates of organ preservation, grade ≥ 3 toxicity, local recurrence, and distant metastasis between treatment groups. Overall survival and disease-free survival were inconsistently reported and remain inconclusive.
CONCLUSION
HDRT improves cCR and increases the proportion of TRG 1-2 in patients with stage I-III rectal cancer, without significant increase in severe toxicity. These findings suggest that HDRT may enhance the feasibility of organ-preserving strategies in selected patients and highlight the potential of individualized, image-guided dose escalation.
Core Tip: Radiotherapy dose escalation has been investigated as a potential approach to improve tumour response in rectal cancer. In this meta-analysis of randomized controlled trials, high-dose radiotherapy (> 54 Gy) increased clinical complete response and the proportion of patients achieving tumour regression grade 1-2 compared with standard-dose radiotherapy. Importantly, dose escalation did not significantly increase severe toxicity. These findings suggest that radiotherapy dose intensification may enhance tumour response and provide supportive evidence for organ preservation strategies in selected patients with stage I-III rectal cancer.
