title: Low rates of local recurrence after surgical resection of rectal cancer suggest a selective policy for preoperative radiotherapy.
abstract: OBJECTIVE
  Preoperative short-course radiotherapy (SCRT) is increasingly recommended to reduce local recurrence after surgery for rectal cancer. Its avoidance may be beneficial, however, if the risk of local recurrence is low. We report a single centre experience which suggests that selective rather than uniform use of SCRT may be the best approach.
  
  
  METHODS
  Analysis was carried out on a prospectively collected unselected series of 1606 patients with rectal cancer treated in one centre. Follow-up was 97% complete. SCRT was performed selectively and all patients had a mesorectal excision.
  
  
  RESULTS
  Among 940 patients undergoing a potentially curative major resection the operative mortality was 4.6%, the permanent stoma rate 23% and the crude 5-year survival 61%. The local recurrence rate after curative anterior resection was 2.9% and 7.7% after abdominoperineal excision. The overall local recurrence rate after a potentially curative major resection was 4.0%.
  
  
  CONCLUSIONS
  The routine use of preoperative radiotherapy for rectal cancer is probably not justified where local recurrence after curative rectal resection is uncommon.
authors.affiliation: Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, UK. asha.senapati@porthosp.nhs.uk
authors.forename: A
authors.initials: A
authors.lastname: Senapati
authors.forename: D P
authors.initials: DP
authors.lastname: O'Leary
authors.forename: K G
authors.initials: KG
authors.lastname: Flashman
authors.forename: A
authors.initials: A
authors.lastname: Parvaiz
authors.forename: M R
authors.initials: MR
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003125:Colostomy / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000517:prevention & control; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D015996:Survival Rate