Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate.
OBJECTIVE
To evaluate the long-term effects on survival and recurrence rates of preoperative radiotherapy in the treatment of curatively operated rectal cancer patients.


METHODS
Of 1,168 randomly assigned patients in the Swedish Rectal Cancer Trial between 1987 and 1990, 908 had curative surgery; 454 of these patients had surgery alone, and 454 were administered preoperative radiotherapy (25 Gy in 5 days) followed by surgery within 1 week. Follow-up was performed by matching against three Swedish nationwide registries (the Swedish Cancer Register, the Hospital Discharge Register, and the Cause of Death Register).


RESULTS
Median follow-up time was 13 years (range, 3 to 15 years). The overall survival rate in the irradiated group was 38% v 30% in the nonirradiated group (P = .008). The cancer-specific survival rate in the irradiated group was 72% v 62% in the nonirradiated group (P = .03), and the local recurrence rate was 9% v 26% (P < .001), respectively. The reduction of local recurrence rates was observed at all tumor heights, although it was not statistically significant for tumors greater than 10 cm from the anal verge.


CONCLUSIONS
Preoperative radiotherapy with 25 Gy in 1 week before curative surgery for rectal cancer is beneficial for overall and cancer-specific survival and local recurrence rates after long-term follow-up.
Folkesson
Joakim
J
Department of Surgical Sciences and Oncology, Uppsala University Hospital, 751 85 Uppsala, Sweden. joakim.folkesson@surgsci.uu.se
Birgisson
Helgi
H
Pahlman
Lars
L
Cedermark
Bjorn
B
Glimelius
Bengt
B
Gunnarsson
Ulf
U
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012042:Registries; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013548:Sweden; D016896:Treatment Outcome