title: Impact of radiotherapy on local recurrence of rectal cancer in Norway.
abstract: BACKGROUND
  The purpose of this study was to analyse the impact of radiotherapy on local recurrence of rectal cancer in Norway after the national implementation of total mesorectal excision (TME).
  
  
  METHODS
  This was a prospective national cohort study of 4113 patients undergoing major resection of rectal carcinoma between November 1993 and December 2001.
  
  
  RESULTS
  The proportion of patients who had radiotherapy before or after operation increased from 4.6 per cent in 1994 to 23.0 per cent in 2001. The cumulative 5-year local recurrence rate decreased from 16.2 to 10.7 per cent. Multivariable analysis showed that preoperative radiotherapy significantly reduced local recurrence (hazard ratio 0.59 (95 per cent confidence interval 0.39 to 0.87)). The use of preoperative radiotherapy in patients from a local hospital offering radiotherapy was 50 per cent higher than that for patients from a hospital without such services (P = 0.003); cumulative 5-year local recurrence rates for these patients were 10.6 and 15.8 per cent respectively (P < 0.001).
  
  
  CONCLUSIONS
  Following national implementation of TME for rectal cancer, increased use of preoperative radiotherapy appeared to reduce recurrence rates further.
authors.affiliation: Department of Digestive Surgery, University Hospital of North Norway, Tromso, Norway. marit.helen.hansen@unn.no
authors.forename: M H
authors.initials: MH
authors.lastname: Hansen
authors.forename: J
authors.initials: J
authors.lastname: Kjaeve
authors.forename: A
authors.initials: A
authors.lastname: Revhaug
authors.forename: M T
authors.initials: MT
authors.lastname: Eriksen
authors.forename: A
authors.initials: A
authors.lastname: Wibe
authors.forename: B
authors.initials: B
authors.lastname: Vonen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control*; D009664:Norway / Q000453:epidemiology; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome