S686
Clinical – Lower GI
ESTRO 2026
Digital Poster Highlight 772
Impact of Total Neoadjuvant Therapy versus Conventional Chemoradiotherapy on Quality of Life in Rectal Cancer: Systematic Review and Meta- Analysis Syadwa Abdul Shukor 1 , Júnior Samuel Alonso de Menezes 2 , Anelise Poluboiarinov Cappellaro 3 , Tan Teng Hwee 1 , Balamurugan Vellayappan 1 , Thais Baccili Cury Megid 4 1 Department of Radiation Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore, Singapore. 2 Departamento de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil. 3 Department of Medical Sciences, Centro Universitário Maurício de Nassau de Barreiras, Barreiras, Brazil. 4 Division of Medical Oncology and Hematology, Dr Georges-L- Dumont University Hospital Centre, Moncton, Canada Purpose/Objective: Total Neoadjuvant Therapy (TNT), which integrates systemic chemotherapy and/or chemoradiotherapy before surgery, has emerged as a preferred strategy for locally advanced rectal cancer (LARC), demonstrating superior pathological complete response and improved distant disease control compared with conventional chemoradiotherapy (CRT). Despite its efficacy, the impact of TNT on patient-reported quality of life (QoL) and functional outcomes remains unclear. This systematic review and meta-analysis provide the first dedicated synthesis assessing whether TNT preserves QoL while delivering superior cancer control. Material/Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, and Cochrane Library up to August 2025 for clinical trials and observational studies comparing TNT with conventional CRT in LARC and reporting QoL using validated instruments, (EORTC QLQ-C30 and QLQ-CR29). Clinical trials focusing on organ preservation strategies were excluded. When multiple QoL timepoints were available, data from the latest post-treatment assessment were extracted. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model based on the latest post-treatment follow-up data. Risk of bias was assessed using ROB-2. Results: Four phase III RCTs (n = 1,199) were included (RAPIDO, UNICANCER PRODIGE 23, STELLAR, Polish-II). Pooled EORTC QLQ-C30 results showed no significant differences between TNT and CRT across global health status [MD -5.59 (-16.12, 4.93); p = 0.30] or functional domains, including physical, role, emotional, cognitive, and social functioning, supporting TNT’s overall
Figure 1. The rate of complete response in the experimental arm and the historical control. Conclusion: The VMAT-SIB TNT regimen indicated promising CR results. By applying the VMAT-SIB in the context of TNT, we can achieve a promising rate of complete organ preservation. As the trial continues to accrue, we should wait for the long-term oncological outcomes like local re-growth and final sphincter preservation, disease-free survival, and overall survival. Keywords: Rectal Cancer; Total Neoadjuvant Therapy; VMAT
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