Improved overall survival for patients with rectal cancer since 1990: the effects of TME surgery and pre-operative radiotherapy.
OBJECTIVE
The aim was to study the effects of the introduction of TME surgery and pre-operative radiotherapy on overall survival (OS) by comparing patients treated in the period before (1990-1995), during (1996-1999) and after (2000-2002) the TME trial.


METHODS
Patients diagnosed with rectal carcinoma in the region of Comprehensive Cancer Centres South and West were used (n=3179).


RESULTS
Five-year OS was, respectively, 56%, 62% and 65% in the pre-trial, trial and post-trial periods (p<0.001). Pre-operative RT was increasingly used over time and significantly related to OS in the post-trial period (p=0.002), but not in the pre-trial and trial periods.


CONCLUSIONS
Population-based OS improved markedly since the introduction of TME surgery. With standardised TME surgery, pre-operative RT improved OS, whereas withholding pre-operative RT was associated with a poorer prognosis. The present study supports that pre-operative RT was correctly introduced as a standard treatment before TME surgery in our national guideline.
den Dulk
Marcel
M
Department of Surgery, K6-R, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
Krijnen
Pieta
P
Marijnen
Corrie A M
CA
Rutten
Harm J
HJ
van de Poll-Franse
Lonneke V
LV
Putter
Hein
H
Meershoek-Klein Kranenbarg
Elma
E
Jansen-Landheer
Marlies L E A
ML
Coebergh
Jan-Willem W
JW
van de Velde
Cornelis J H
CJ
D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome