title: Outcomes following a limited approach to radiotherapy in rectal cancer.
abstract: BACKGROUND
  Variation in the use of neoadjuvant and adjuvant radiotherapy for rectal cancer suggests an opportunity to avoid it in all but patients at highest risk of local recurrence.
  
  
  METHODS
  Between 1 July 1999 and 1 February 2006, patients with primary rectal cancer were treated by a single surgeon operating at McMaster University, Hamilton, Ontario, Canada. Digital rectal examination and pelvic computed tomography were used to determine whether the mesorectal margin was threatened by tumour and thus whether preoperative radiotherapy would be needed. The study outcome was local tumour recurrence.
  
  
  RESULTS
  Forty-six (48 per cent) of 96 patients received preoperative radiation therapy. The median follow-up was 4·2 years. Tumours were fixed or tethered in 31 (67 per cent) of the 46 irradiated patients. In contrast, no tumour was fixed in unirradiated patients and only ten (20 per cent) of the 50 tumours were tethered. The proportion of patients with stage I or II tumours based on final pathology was similar: 61 per cent (28 of 46) and 56 per cent (28 of 50) in irradiated and unirradiated groups respectively (P = 0·287). There were four (9 per cent) and two (4 per cent) local recurrences among irradiated and unirradiated patients respectively (P = 0·422).
  
  
  CONCLUSIONS
  Limiting preoperative radiotherapy in rectal cancer to patients with a threatened circumferential margin does not compromise patient outcome.
authors.affiliation: Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. marko.simunovic@jcc.hhsc.ca
authors.forename: M
authors.initials: M
authors.lastname: Simunovic
authors.forename: S
authors.initials: S
authors.lastname: Jacob
authors.forename: A J
authors.initials: AJ
authors.lastname: Coates
authors.forename: K
authors.initials: K
authors.lastname: Vogt
authors.forename: B J
authors.initials: BJ
authors.lastname: Moran
authors.forename: R J
authors.initials: RJ
authors.lastname: Heald
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery; D000368:Aged; D051517:Digital Rectal Examination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D010386:Pelvic Neoplasms / Q000209:etiology; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome