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World J Gastrointest Oncol. Aug 15, 2026; 18(8): 120904
Published online Aug 15, 2026. doi: 10.4251/wjgo.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, 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 Pharma
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 Af
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
Revised: April 8, 2026
Accepted: June 2, 2026
Published online: August 15, 2026
Processing time: 149 Days and 21.2 Hours
Core Tip
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.