Harm and benefits of short-term pre-operative radiotherapy in patients with resectable rectal carcinomas.
OBJECTIVE
To weigh the harms and benefits of short-term pre-operative radiotherapy in the treatment of resectable rectal cancer.


METHODS
The benefits (reduction of local recurrence) and harm (increase of short-term complications) of short-term pre-operative radiotherapy are balanced using a model which classifies patients in one of five outcome combinations; 1-benefit without additional harm, 2-benefit with additional harm, 3-no benefit, no additional harm, 4-no benefit but additional harm, 5-mortality due to combined treatment. The results of four randomised clinical trials (RCT) which study the addition of short-term pre-operative radiotherapy in rectal cancer were classified according to this model.


RESULTS
Five to thirteen percent of the patients have benefit without additional harm of pre-operative radiotherapy, while 0-2% have benefit with additional harm; 74-87% has neither benefit nor additional harm and 6-11% have no benefit but additional harm. A small percentage of patients (1-6%) dies post-operatively as a result of the addition of radiotherapy.


CONCLUSIONS
This model provides a transparent appreciation of the harmful and beneficial effects of any treatment modality investigated by means of a randomised clinical trial. As for short-term pre-operative radiotherapy in resectable rectal cancer is shown, a small percentage of patients benefits from such treatment. Most patients have neither benefit nor additional harm, while a small percentage suffers from additional harm while not receiving any benefit.
Bakx
R
R
Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands. r.bakx@amc.uva.nl
Emous
M
M
Legemate
D A
DA
Zoetmulder
F A N
FA
van Tienhoven
G
G
Bemelman
W A
WA
van Lanschot
J J B
JJ
D002277:Carcinoma / Q000532:radiotherapy* / Q000601:surgery; D002423:Cause of Death; D006801:Humans; D015233:Models, Statistical; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011300:Preoperative Care; D011878:Radiotherapy / Q000009:adverse effects; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome