title: Multicentre prospective audit of surgical outcomes and acute complications following short course pre-operative radiotherapy for resectable rectal cancer.
abstract: BACKGROUND
  The addition of short course pre-operative radiotherapy to total mesorectal excision reduces local recurrence in resectable adenocarcinoma of the rectum. In a previous retrospective study potential factors associated with early complications following this combination were identified. The aim of this study was to examine these relationships in a prospective multicentre audit.
  
  
  METHODS
  One hundred and seven patients who received short course pre-operative radiotherapy in four cancer centres between 1 October 2001 and 30 September 2002 were included. Data including patient age, radiotherapy field length, overall treatment time, operation type, surgical outcomes and complications occurring within 3 months of the 1st day of radiotherapy were collected. These were compared and combined with the previously studied cohort of 176 patients treated at one centre between 1st January 1998 and 31st December 1999.
  
  
  RESULTS
  In the prospective cohort only patient age (P=0.001) was significantly associated with acute complications. However, both the overall treatment time (median 9.0 vs 11.0 days P <0.0001) and field length (median 16.6 vs 17.0 cm P=0.03) were significantly shorter in this cohort when compared to the previous retrospective study. In patients from both studies (n=283), increasing age (P=0.002) and field length (independent of operation type) (P=0.02) were independently associated with an increased risk of acute complications.
  
  
  CONCLUSIONS
  This study suggests that meticulous selection of patients for short course pre-operative radiotherapy and smaller planning target volumes may be associated with a lower risk of acute complications. The use of MRI scanning to stage pelvic disease may reduce the number of patients with R1 resections receiving short course pre-operative radiotherapy.
authors.affiliation: Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Giridharan
authors.forename: B
authors.initials: B
authors.lastname: Vakkalanka
authors.forename: M S
authors.initials: MS
authors.lastname: Anwar
authors.forename: J I
authors.initials: JI
authors.lastname: Geh
authors.forename: J
authors.initials: J
authors.lastname: Glaholm
authors.forename: M
authors.initials: M
authors.lastname: Churn
authors.forename: F
authors.initials: F
authors.lastname: Adab
authors.forename: R
authors.initials: R
authors.lastname: Grieve
authors.forename: C
authors.initials: C
authors.lastname: McConkey
authors.forename: A
authors.initials: A
authors.lastname: Hartley
mesh_terms: D000208:Acute Disease; D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D000367:Age Factors; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome