kortdurende radiotherapie plus chemotherapie geeft betere overall overleving en langere ziekteprogressievrije tijd vergeleken met langdurige chemoradiotherapie voor lokaal gevorderde rectumkanker

Zie ook in gerelateerde artikelen

30 juli 2026. Bron: Stellar studie, Journal of Clinical Oncology d.d. July 27, 2026

Uit een update van de resultaten op 5-jaars meting van de fase III studie STELLAR blijkt dat na operatie kortdurende radiotherapie / bestraling plus chemotherapie betere overall overleving (OS) en langere ziektevrije tijd geeft in vergelijking met langdurige chemoradiotherapie voor lokaal gevorderde rectumkanker / endeldarmkanker.

Uit het studieverslag:

Na een mediane follow-up van 68,7 maanden was de ziektevrije overleving na vijf jaar 62,0% in de groep patiënten die kortdurende radiotherapie / bestraling plus chemotherapie (TNT) hadden gekregen en 58,7% in de groep die langdurige chemoradiotherapie hadden gehad.
De algehele overleving na vijf jaar (OS) was significant hoger met kortdurende radiotherapie / bestraling plus chemotherapie - 78,1% versus 69,7%.
De percentages uitzaaiingen op afstand en locoregionale recidieven waren vergelijkbaar tussen de twee groepen.
Bij patiënten met een hoog risico was kortdurende radiotherapie / bestraling plus chemotherapie (TNT) geassocieerd met een verbeterde overall overleving (OS) en vertoonde een statistisch niet-significante trend naar een verbeterde ziektevrije overleving.
Bij patiënten met uitzaaiingen op afstand (DM) of locoregionale recidieven (LRR) was kortdurende radiotherapie / bestraling plus chemotherapie (TNT) geassocieerd met zowel een verbeterde ziektevrije overleving na een recidief als een verbeterde overleving na een recidief.

De conclusie van de onderzoekers is dan ook dat deze studieresultaten suggereren dat kortdurende radiotherapie / bestraling gevolgd door systemische chemotherapie een beter en duurzaam overlevingsvoordeel biedt en een haalbaar alternatief is voor gevorderde rectumkanker / endeldarmkanker, met name bij patiënten met een hoog risico op de ziekte.

Wat is het verschil tussen chemoradiotherapie en radiotherapie / bestraling plus chemotherapie?

Bij chemoradiotherapie worden deze twee behandelingen gelijktijdig gegeven terwijl bij kortdurende radiotherapie / bestraling de chemotherapie pas na de bestraling wordt gegeven. Zie ook wat de richtlijn van Federatie medische specialisten hierover zegt.

Het volledige studieverslag is onder bepaalde voorwaarden gratis in te zien of te downloaden. Hier het abstract van de studie:

doi: 10.1200/JCO-25-02387. Online ahead of print.

Abstract

This updated analysis of the STELLAR trial reports 5-year outcomes comparing short-course radiotherapy followed by chemotherapy (SCRT-based total neoadjuvant therapy ) with standard long-course chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). Patients with distal or middle-third LARC were randomly assigned to receive either SCRT-based TNT or CRT. At a median follow-up of 68.7 months, the 5-year disease-free survival (DFS) was 62.0% in the TNT group and 58.7% in the CRT group, with a hazard ratio (HR) for DFS of 0.849 (95% CI, 0.662 to 1.089). Five-year overall survival (OS) was significantly higher with TNT (78.1% v 69.7%; HR, 0.739 [95% CI, 0.550 to 0.993]). Distant metastasis (DM) and locoregional recurrence (LRR) rates were similar between the two groups. In high-risk patients (per European Society for Medical Oncology criteria), TNT was associated with improved OS (HR, 0.663 [95% CI, 0.469 to 0.937]) and showed a nonsignificant trend toward improved DFS (HR, 0.765 [95% CI, 0.568 to 1.032]). In patients with DM or LRR, TNT was associated with both improved postrecurrence progression-free survival (HR, 0.691 [95% CI, 0.497 to 0.961]) and postrecurrence survival (HR, 0.698 [95% CI, 0.490 to 0.994]). These results suggest that SCRT-based TNT provides a durable survival advantage and is a viable alternative to CRT, especially in patients with high-risk disease.

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The STELLAR trial was supported by grants from the Chinese Academy of Medical Science Innovation Fund for Medical Sciences (CIFMS, 2016-I2M-1-001); National Key Projects of Research and Development of China (2016YFC0904600); National Natural Science Foundation of China (82073352); Key Projects of Capital Health Development (2020-1-402); Collaborative Innovation Center for Cancer Medicine (CICCM, XT2015-03); Beijing Hope Run Special Fund of Cancer Foundation of China (LC2015L23) and Sanming Project of Medicine in Shenzhen (No. SZSM201612063).

CLINICAL TRIAL INFORMATION

NCT02533271

J. Jin and Y.T. contributed equally as first authors. J. Jin, Y.-X.L., Y.-H.G., S.-X.L., W.-L.W., L.-C.W., H.-Z.Z., and X.-S.W. contributed equally as corresponding authors.

AUTHOR CONTRIBUTIONS

Conception and design: Jing Jin, Ye-Xiong Li

Financial support: Jing Jin, Ye-Xiong Li

Administrative support: Jing Jin, Hai-Zeng Zhang, Xi-Shan Wang, Li-Chun Wei, Wen-Ling Wang, Shi-Xin Liu, Yuan-Hong Gao, Ye-Xiong Li

Provision of study materials or patients: Yuan Tang, Ning Li, Wen-Yang Liu, Ning-Ning Lu, Yong Cai, Yong-Heng Li, Yuan Zhu, Guang-Hui Cheng, Hong-Yan Zhang, Xin Wang, Su-Yu Zhu, Jun Wang, Gao-Feng Li, Jia-Lin Yang, Kuan Zhang, Yihebali Chi, Lin Yang, Hai-Tao Zhou, Ai-Ping Zhou, Hui Fang, Shu-Lian Wang, Hai-Zeng Zhang, Xi-Shan Wang, Li-Chun Wei, Wen-Ling Wang, Shi-Xin Liu, Yuan-Hong Gao

Collection and assembly of data: Jing Jin, Yuan Tang, Si-Lin Chen, Shuai Li, Ye-Xiong Li

Data analysis and interpretation: Jing Jin, Yuan Tang, Chen Hu, Si-Lin Chen, Shuai Li, Ye-Xiong Li

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Multicenter, Randomized, Phase III Trial of Short-Term Radiotherapy Plus Chemotherapy Versus Long-Term Chemoradiotherapy in Locally Advanced Rectal Cancer (STELLAR)

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Chen Hu

Consulting or Advisory Role: Merck Sharp & Dohme, D1 Medical Technology

Ai-Ping Zhou

Consulting or Advisory Role: Pfizer, Novartis

No other potential conflicts of interest were reported.

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