title: Assessing the effectiveness of a guideline recommendation for pre-operative radiochemotherapy in rectal cancer.
abstract: OBJECTIVE
  To ascertain the degree of adherence to the guideline recommendation on pre-operative RT/ChT for stage-II and -III patients in Catalonian public hospitals, and its impact on local recurrence among rectal cancer patients.
  
  
  METHODS
  Data were derived from a multicentre retrospective cohort study of patients who underwent curative-intent surgery for primary rectal cancer at Catalonian public hospitals in 2005 and 2007.
  
  
  RESULTS
  The study covered 1229 patients with TNM stage-II or -III primary rectal cancer. Of these patients, 54.5% underwent pre-operative RT/ChT; 14.9% underwent post-operative RT (± chemotherapy); and 30.6% did not undergo any RT. The crude local recurrence rate at 2years was 4.1% and the crude distant recurrence rate at 2years was 6.5%. The results of the univariate analyses showed a local-recurrence hazard ratio of 1.84 for the group of patients that received no RT versus the group that received pre-operative RT/ChT (p<0.01).
  
  
  CONCLUSIONS
  This is the first population-based study in Catalonia to support the use of pre-operative RT/ChT in rectal cancer patients because, in line with the results of population-based studies reported from other countries, its application, compared to non-application of RT, was found to lead to a clear reduction in the probability of local recurrence.
authors.affiliation: Catalonian Cancer Strategy, Department of Health, Barcelona, Spain. pmanchon@iconcologia.net
authors.forename: Paula
authors.initials: P
authors.lastname: Manchon-Walsh
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Borras
authors.forename: Josep Alfons
authors.initials: JA
authors.lastname: Espinas
authors.forename: Luisa
authors.initials: L
authors.lastname: Aliste
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies