ORIGINAL RESEARCH article
Front. Surg.
Sec. Colorectal and Proctological Surgery
Comparative Safety and Short-Term Outcomes of Intraoperative Radiotherapy versus Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer: A Retrospective Study
Provisionally accepted
Zhijie Gong1*
Yingze Li2
Jun Zhou2Yanjie Deng3Yinghao He1WeiWei Wang2Qiangbang Yang2Jian Pan2Minghui Ma2*- 1The First School Clinical Medicine, Southern Medical University, Guangzhou, China
- 2Maoming People's Hospital, Maoming, China
- 3Guangdong Medical University, Zhanjiang, China
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Purpose: Neoadjuvant chemoradiotherapy (nCRT) constitutes an integral component of the standard therapeutic strategy for locally advanced rectal cancer (LARC) but carries cumulative toxicity, cost, and occasional non-response. Intraoperative radiotherapy (IORT) delivers a single high dosage directly to the tumor bed and may overcome these limitations. We compared short-term efficacy and safety of low-kilovoltage(kV) X-ray IORT with long-course nCRT. Methods: LARC patients treated at Maoming People's Hospital (2022-2024) were retrospectively reviewed. The nCRT cohort received 45–50 Gy radiotherapy plus capecitabine before surgery; the IORT cohort underwent INTRABEAM low-kV X-ray IORT (12.5–20 Gy) during surgery. Disease-free survival (DFS), overall survival (OS), postoperative complications, and recurrence were analyzed. Survival was estimated by Kaplan–Meier curves. Results: A total of 67 patients were included (46 in nCRT, 21 in IORT). Kaplan–Meier analysis showed no significant difference in DFS or OS between the IORT and nCRT groups (DFS P = 0.669; OS P = 0.864). 3-year DFS (53.7 % vs 52.8 %, P = 0.669) and OS (89.0 % vs 78.4 %, P = 0.864) did not differ between IORT and nCRT. Early postoperative bowel obstruction and urinary retention were more frequent after IORT, although neither difference was significant; long-term complications and recurrence patterns remained comparable between the groups. Conclusion: Single-fraction low-kV IORT provides short-term survival equivalent to standard nCRT with acceptable perioperative safety. It is a viable option for LARC patients unable or unwilling to undergo prolonged nCRT, although vigilance for early gastrointestinal and urinary complications is warranted.
Keywords: locally advanced rectal cancer1, intraoperative radiotherapy2, neoadjuvantchemoradiotherapy3, safety and efficacy4, retrospective study5
Received: 25 Sep 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Gong, Li, Zhou, Deng, He, Wang, Yang, Pan and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zhijie Gong
Minghui Ma
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