SynthesisBMC medicine2026
Comparative efficacy of neoadjuvant short-course versus long-course radiotherapy-based regimens with or without immunotherapy for locally advanced pMMR rectal cancer: a systematic review and network meta-analysis.
Synthesis in BMC medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Explainable AI-Derived Spatial Pathological Features of Tumor, Necrosis, and Lymphocytes Identify Key Histological Signatures for Residual Cancer Burden Assessment in Breast Cancer.Diagnostics (Basel, Switzerland) · 2026Article
- Review
- Total Neoadjuvant Therapy, Organ Preservation and Beyond: A State-of-the-Art Systematic Review and Critical Appraisal of Locally Advanced Rectal Cancer Management.Diseases (Basel, Switzerland) · 2026Review
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Authors and funding
6 authors.
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Abstract
backgroundThe integration of immunotherapy with neoadjuvant therapy for proficient mismatch repair (pMMR) locally advanced rectal cancer (LARC) is a promising strategy. However, the optimal treatment platform, a short-course radiotherapy (SCRT)-based regimen or a long-course chemoradiotherapy (LCRT)-based regimen, remains uncertain due to the absence of direct comparative trials. This network meta-analysis (NMA) aimed to compare the efficacy and safety of these two platforms, each with or without immune checkpoint inhibitors (ICIs).
methodsWe systematically searched PubMed/MEDLINE, Embase, and Cochrane Library from inception to September 20, 2025, for randomized controlled trials (RCTs) comparing neoadjuvant SCRT-based or LCRT-based regimens combined with ICIs versus the corresponding regimens without ICIs in LARC. A frequentist NMA was performed using random-effects models. The co-primary outcomes were the curative-intent response rate [a composite of pathological complete response (pCR) or clinical complete response followed by a Watch-and-Wait strategy (WW)] and the incidence of grade ≥ 3 treatment-related adverse events (TRAEs). The pCR rate was a key secondary endpoint. Treatments were ranked using surface under the cumulative ranking curve (SUCRA) probabilities.
resultsSeven RCTs (1132 patients) evaluating four strategies (SCRT-based regimen alone, SCRT-based regimen with ICIs, LCRT-based regimen alone, and LCRT-based regimen with ICIs) were included. For the primary endpoint of curative-intent response, SCRT + ICIs had the highest probability of being the most effective treatment (SUCRA, 98.5%). SCRT + ICIs significantly outperformed SCRT alone (RR, 1.82; 95% CI, 1.27-2.60) and LCRT alone (RR, 2.23; 95% CI, 1.33-3.76). It also showed a numerical, but non-significant, advantage over LCRT + ICIs (RR, 1.63; 95% CI, 0.88-3.02). The addition of ICIs to LCRT resulted in a numerical increase in response (RR, 1.37; 95% CI, 0.98-1.90) compared to LCRT alone. Results for the pCR rate were consistent in treatment ranking. Regarding safety, the addition of ICIs to either platform was not associated with a significant increase in grade ≥ 3 TRAEs, and no significant difference was observed between the two combination strategies (SCRT + ICIs vs. LCRT + ICIs: RR, 0.87; 95% CI, 0.38-2.04).
conclusionsThis NMA suggests that the SCRT-based platform may be the preferred option to combine with immunotherapy in pMMR LARC. The results support direct comparison of these platforms in future phase III trials focused on long-term survival and organ preservation.
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