Introduction For patients with locally advanced rectal cancer (LARC), neoadjuvant chemoradiotherapy (NCRT) followed by surgery and adjuvant chemotherapy (ACRT) has long been the standard treatment. Disease-free survival (DFS) is a critical endpoint that captures the time to recurrence, either local or distant, or death from any cause. This study evaluated the impact of different treatment strategies on DFS in patients with LARC.

Methods We retrospectively reviewed 590 patients with LARC, aged 18 years or older, treated between 2007 and 2017. Eligible tumors were located within 12 cm of the anal verge. Patients were categorized into two groups: those who received NCRT (n=269) and those who received ACRT (n=321). DFS at 1, 3, and 5 years was analyzed using Kaplan–Meier estimates, with log-rank and Breslow tests applied for comparisons.

Results The overall median DFS was 79.2 months. Patients in the NCRT group achieved a longer median DFS (75.4 months) compared with those in the ACRT group (68.2 months). For the entire cohort, 1-, 3-, and 5-year DFS rates were 83%, 65%, and 58%, respectively. When stratified by treatment type, DFS rates were higher in the NCRT group (89%, 72%, and 61%) compared with the ACRT group (76%, 59%, and 54%) (p=0.005, Breslow test) (Figure 1).

Conclusion our findings suggest that NCRT provides a meaningful survival advantage over ACRT in patients with LARC, highlighting its value as the preferred treatment strategy in this setting. Keywords: Neoadjuvant, Adjuvant, Chemoradiotherapy, Disease-free survival, locally advanced rectal cancer