Hypofractionated radiotherapy in the management of rectal tumours

This review aims to explore the radiobiological rationale and clinical evidence supporting the use of hypofractionated radiotherapy in the management of rectal tumours, particularly in neoadjuvant treatment strategies and organ preservation approaches. An overview of key randomized controlled trials on hypofractionated radiotherapy, also called short-course radiotherapy, was conducted. Clinical trials have demonstrated oncological equivalence between hypofractionated radiotherapy and standard long-course chemoradiotherapy in terms of overall survival and local recurrence, but short-course radiotherapy represents a relevant therapeutic option for frail or elderly patients. In the total neoadjuvant treatment context, short-course radiotherapy combined with consolidation chemotherapy improves distant control but may increase the risk of local recurrence. Recent studies suggest that short-course radiotherapy can lead to organ preservation when followed by transanal surgery or active surveillance in well-selected patients, and that its combination with immune checkpoint inhibitors can safely increase complete response rates. Its use in total neoadjuvant treatment, immunotherapy combinations, and organ preservation strategies requires careful patient selection and further comparative trials to refine its indications.