title: Peripheral leucocyte count variations in rectal cancer treatment.
abstract: OBJECTIVE
  Mortality after curative surgery for rectal cancer is increased if surgery is not performed within a week of completed short course radiotherapy. A link to the suppression of leucocytes after neoadjuvant radiotherapy has been suggested. This study investigates the effects of radiotherapy on peripheral leucocyte counts, complications and survival.
  
  
  METHODS
  Patient data variables from a retrospective database (Local and National Swedish Registries) of a total of 926 consecutive patients treated for rectal cancer disease at two surgical units (1993-2004) were analysed for leucocyte counts and mortality. In all 310 patients received radiotherapy. Mean follow-up time was 2.8 years.
  
  
  RESULTS
  There was a marked suppression of leucocytes in the irradiated groups coupled with a reduction in leucocyte response to surgery (p<0.05) compared to non-irradiated patients. Long course radiotherapy resulted in a better postoperative leucocyte response. Irradiated patients with a low post/preoperative leucocyte ratio had higher complication rates. No association between leucocyte response and survival was seen in the irradiated group.
  
  
  CONCLUSIONS
  Postoperative leucocytosis is impaired after neoadjuvant radiotherapy, independent of latency period to surgery. Irradiated patients with a suppression of leucocyte response had significantly higher complication rates. The true extent of survival could not be measured in radiotherapy groups due to the short median follow-up period.
authors.affiliation: Department of Surgery, Malmö University Hospital, UMAS, Malmö, Sweden. louis.johnson@med.lu.se
authors.forename: L B
authors.initials: LB
authors.lastname: Johnson
authors.forename: D
authors.initials: D
authors.lastname: Adawi
authors.forename: S
authors.initials: S
authors.lastname: Sandberg
authors.forename: B
authors.initials: B
authors.lastname: Ottochian
authors.forename: C
authors.initials: C
authors.lastname: Albertsen
authors.forename: J
authors.initials: J
authors.lastname: Manjer
authors.forename: E
authors.initials: E
authors.lastname: Zoucas
authors.forename: M
authors.initials: M
authors.lastname: Bohe
authors.forename: B
authors.initials: B
authors.lastname: Jeppsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012004:Rectal Neoplasms / Q000097:blood* / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D016019:Survival Analysis; D055815:Young Adult