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SCRT plus ICI associated with higher CR and pCR rates than LCRT in rectal cancerSpecific radiation types may improve outcomes for rectal cancer patients

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Key Takeaway
Note that SCRT plus ICI is associated with higher CR and pCR rates than LCRT plus ICI in pMMR/MSS rectal cancer.

This meta-analysis evaluated the impact of neoadjuvant PD-1/PD-L1 inhibitors combined with chemoradiotherapy (CRT) in patients with proficient mismatch repair (pMMR) or microsatellite-stable (MSS) locally advanced rectal cancer. The analysis included a total sample size of 972 patients to compare LCRT-based versus SCRT-based regimens.

The pooled CR rate was 44% (95% CI 0.38-0.49). When comparing radiation types, SCRT plus ICI showed a 50% CR rate compared to 39% for LCRT plus ICI (P = 0.03). Regarding pathologic complete response (pCR), the pooled rate was 40% (95% CI 0.36-0.45). In the direct comparison of radiation types for pCR, SCRT plus ICI showed a rate of 47% compared to 34% for LCRT plus ICI.

While the data suggests a positive association between SCRT and higher response rates when combined with immune checkpoint inhibitors, the study notes that the specific interaction between immunotherapy duration and radiotherapy fractionation is not fully detailed. Clinical application should consider these findings as an association between radiation techniques and response rates in this specific patient population.

How this fits prior evidence

This meta-analysis addresses a gap in understanding how radiation techniques interact with immunotherapy in rectal cancer. While prior coverage established that PD-1/PD-L1 inhibitors improve survival in gastric and esophageal junction cancer and HNSCC, this study specifically explores the impact of SCRT versus LCRT in the context of ICI for rectal cancer. It provides specific data on response rates (CR and pCR) for this specific indication.

Doctors are looking for better ways to treat locally advanced rectal cancer, especially for patients whose tumors are harder to treat with standard methods. A review of data from 972 patients looked at how adding immunotherapy drugs, like PD-1 or PD-L1 inhibitors, changes the results when combined with different types of radiation.

The findings show that patients who received a specific type of radiation called SCRT along with immunotherapy had higher complete response rates than those who received LCRT. Specifically, the SCRT group saw a 50% complete response rate compared to 39% for the LCRT group. The study also found higher pathologic complete response rates for the SCRT group at 47% compared to 34% for the LCRT group.

While these numbers show a clear difference in how patients responded to the treatment, the study did not report on specific side effects or how well patients tolerated the drugs. These results suggest that the type of radiation used alongside immunotherapy can significantly impact how well the cancer responds to treatment.

What this means for you:
Patients receiving SCRT plus immunotherapy showed higher response rates than those receiving LCRT plus immunotherapy.

Common questions

What is the difference between SCRT and LCRT in this study?

The study compared two types of radiation used with immunotherapy. Patients who received SCRT plus immunotherapy had a 50% complete response rate. Those who received LCRT plus immunotherapy had a 39% complete response rate. These results suggest that SCRT was more effective in achieving a complete response for these patients.

How many patients were included in this research?

The analysis included data from 972 patients who had locally advanced rectal cancer. These patients were specifically those with proficient mismatch repair or microsatellite-stable tumors. The study focused on how adding immunotherapy to their radiation and chemotherapy changed their outcomes.

What are the response rates for these treatments?

The study found a pooled complete response rate of 44% for the group receiving immunotherapy with radiation. It also found a 40% pathologic complete response rate. When looking specifically at radiation types, the SCRT group showed higher rates of both complete and pathologic complete responses compared to the LCRT group.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BackgroundNeoadjuvant PD-1/PD-L1 combined with chemoradiotherapy (CRT) has shown encouraging complete response (CR) rates in proficient mismatch repair (pMMR) or microsatellite-stable (MSS) locally advanced rectal cancer (LARC), yet immunotherapy duration varies widely across trials and its interaction with radiotherapy fractionation remains unclear.MethodsPubMed, Embase, and Cochrane Library were searched through October 8, 2025 for prospective trials of PD-1/PD-L1 inhibitors plus CRT in pMMR/MSS LARC. Random-effects models pooled CR (cCR+pCR) rates, with subgroup analyses and study-level meta-regression conducted to explore sources of heterogeneity. A linear probit model and an interactive quadratic probit model were applied to assess associations between treatment duration and response (PROSPERO number CRD420251253156).ResultsEighteen trials (972 patients; 10 LCRT-based and 8 SCRT-based) were included. Pooled CR and pCR rates were 44% (95% CI 0.38–0.49) and 40% (95% CI 0.36–0.45). CR was higher with SCRT plus ICI than LCRT plus ICI (50% vs 39%; P = 0.03), and pCR similarly favored SCRT (47% vs 34%; P 
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