Five-Year Outcomes of Short-Term Radiotherapy Plus Chemotherapy Versus Long-Term Chemoradiotherapy for Locally Advanced Rectal Cancer: Updated Results of the STELLAR Trial

This updated analysis of the STELLAR trial reports 5-year outcomes comparing short-course radiotherapy followed by chemotherapy (SCRT-based total neoadjuvant therapy [TNT]) with standard long-course chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). Patients with distal or middle-third LARC were randomly assigned to receive either SCRT-based TNT or CRT. At a median follow-up of 68.7 months, the 5-year disease-free survival (DFS) was 62.0% in the TNT group and 58.7% in the CRT group, with a hazard ratio (HR) for DFS of 0.849 (95% CI, 0.662 to 1.089). Five-year overall survival (OS) was significantly higher with TNT (78.1% v 69.7%; HR, 0.739 [95% CI, 0.550 to 0.993]). Distant metastasis (DM) and locoregional recurrence (LRR) rates were similar between the two groups. In high-risk patients (per European Society for Medical Oncology criteria), TNT was associated with improved OS (HR, 0.663 [95% CI, 0.469 to 0.937]) and showed a nonsignificant trend toward improved DFS (HR, 0.765 [95% CI, 0.568 to 1.032]). In patients with DM or LRR, TNT was associated with both improved postrecurrence progression-free survival (HR, 0.691 [95% CI, 0.497 to 0.961]) and postrecurrence survival (HR, 0.698 [95% CI, 0.490 to 0.994]). These results suggest that SCRT-based TNT provides a durable survival advantage and is a viable alternative to CRT, especially in patients with high-risk disease.

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Journal
Journal of Clinical Oncology
Published
2026-07-27
DOI
https://doi.org/10.1200/jco-25-02387
Primary Topic
Colorectal Cancer Surgical Treatments
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article
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article

Five-Year Outcomes of Short-Term Radiotherapy Plus Chemotherapy Versus Long-Term Chemoradiotherapy for Locally Advanced Rectal Cancer: Updated Results of the STELLAR Trial

Hui Fang, Y T, Yuan Tang, Chen Hu et al.
Journal of Clinical Oncology
Colorectal Cancer Surgical Treatments
article

Five-Year Outcomes of Short-Term Radiotherapy Plus Chemotherapy Versus Long-Term Chemoradiotherapy for Locally Advanced Rectal Cancer: Updated Results of the STELLAR Trial

Hui Fang, Y T, Yuan Tang, Chen Hu, Hu Zhou, Haizeng Zhang, Jun Wang, Ye‐Xiong Li, S Y Chen, Shuangmei Zou, Weiwei Xiao, Yuanhong Gao, Jie Yang, Shuai Li, Gaofeng Li, Lin Yang, Shixin Liu, Jing Jin, Ting Zhao, Lichun Wei, Cai Y, Yuan Zhu, Huiying Ma, T.F. Xu, Yong-heng Li, N N Lu, Ke Liu, Ai-Ping Zhou, Shu-Lian Wang, Xi-Shan Wang, Jun Jiang, Wen-Ling Wang, Ning Li, Xin Wang, Hong-Yan Zhang, Ming-Yuan He, Kuan Zhang, Li-Ming Jiang
article en

Abstract

This updated analysis of the STELLAR trial reports 5-year outcomes comparing short-course radiotherapy followed by chemotherapy (SCRT-based total neoadjuvant therapy [TNT]) with standard long-course chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). Patients with distal or middle-third LARC were randomly assigned to receive either SCRT-based TNT or CRT. At a median follow-up of 68.7 months, the 5-year disease-free survival (DFS) was 62.0% in the TNT group and 58.7% in the CRT group, with a hazard ratio (HR) for DFS of 0.849 (95% CI, 0.662 to 1.089). Five-year overall survival (OS) was significantly higher with TNT (78.1% v 69.7%; HR, 0.739 [95% CI, 0.550 to 0.993]). Distant metastasis (DM) and locoregional recurrence (LRR) rates were similar between the two groups. In high-risk patients (per European Society for Medical Oncology criteria), TNT was associated with improved OS (HR, 0.663 [95% CI, 0.469 to 0.937]) and showed a nonsignificant trend toward improved DFS (HR, 0.765 [95% CI, 0.568 to 1.032]). In patients with DM or LRR, TNT was associated with both improved postrecurrence progression-free survival (HR, 0.691 [95% CI, 0.497 to 0.961]) and postrecurrence survival (HR, 0.698 [95% CI, 0.490 to 0.994]). These results suggest that SCRT-based TNT provides a durable survival advantage and is a viable alternative to CRT, especially in patients with high-risk disease.

Journal of Clinical Oncology
Hebei Medical University (CN), University of Science and Technology of China (CN), Fujian Medical University (CN), Johns Hopkins University (US), Guiyang Medical University (CN), Sun Yat-sen University (CN), Jilin University (CN), Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Peking University (CN), Sichuan University (CN), National Cancer Center (US), West China Hospital of Sichuan University (CN), Peking University Cancer Hospital (CN), Zhejiang Cancer Hospital (CN), Shanxi Provincial Cancer Hospital (CN), Fourth Hospital of Hebei Medical University (CN), Affiliated Hospital of Guizhou Medical University (CN), Qinghai Red Cross Hospital (CN), Hunan Cancer Hospital (CN), Sichuan Cancer Hospital (CN), Cancer Hospital of Chinese Academy of Medical Sciences (CN), Sun Yat-sen University Cancer Center (CN), Xijing Hospital (CN), Union Hospital (CN), Sidney Kimmel Comprehensive Cancer Center (US), Air Force Medical University (CN)
Openalex Percentile: Top 12%
Colorectal Cancer Surgical Treatments
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