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

At a median follow-up of 68.7 months, short-course radiotherapy-based total neoadjuvant therapy (STELLAR trial) yielded 5-year overall survival of 78.1% versus 69.7% with standard long-course chemoradiotherapy (HR 0.739; 95% CI 0.550-0.993) in locally advanced rectal cancer. The difference in 5-year disease-free survival was not statistically significant (62.0% vs 58.7%; HR 0.849; 95% CI 0.662-1.089), and distant metastasis and locoregional recurrence rates were similar between groups. The clearest benefit was in high-risk patients per ESMO criteria (overall survival HR 0.663; 95% CI 0.469-0.937). The authors conclude that the short-course regimen is a durable alternative to chemoradiotherapy, particularly in high-risk disease.