title: Modern Treatment of Rectal Cancer Closes the Gap Between Common Adenocarcinoma and Mucinous Carcinoma.
abstract: BACKGROUND
  Mucinous carcinoma (MC) is a distinct form of rectal cancer (RC) comprising 10 % of all cases and has been associated with an impaired prognosis compared with non-mucinous adenocarcinoma (AC). The benefit of today's modern treatment for MC patients is unknown but a prospective randomized trial to answer this does not seem feasible. This study provides an analysis of the modern treatment of rectal MC and efficacy of preoperative therapies for MC patients.
  
  
  METHODS
  Data from three large (trial) cohorts were used. Data from the Netherlands Cancer Registry (NCR) were used to analyze the prognosis of RC patients over time (N = 38,035). To study the benefit of preoperative short-term radiotherapy, patients from the total mesorectal excision (TME) trial (N = 1,530) were selected, and the benefit from preoperative chemoradiotherapy was analyzed with data on 540 locally advanced RC (LARC) patients from two hospitals.
  
  
  RESULTS
  Data from the NCR confirmed that 5-year overall survival for MC was significantly worse from 1989 to 1998, but no longer different from AC from 1999 onwards. MC patients had a higher rate of positive circumferential resection margin than AC patients (TME trial 27.2 vs. 16.5 %, p = 0.006; LARC cohort 34.5 vs. 9.8 %, p < 0.0001), but there was no difference in outcome between MC and AC patients after preoperative short-term radiotherapy or chemoradiotherapy.
  
  
  CONCLUSIONS
  Modern treatment of RC has benefited MC patients, leading to equal survival for MC and AC patients. Enhancements in the fields of imaging and quality of surgery have improved outcome and preoperative therapies should be recommended for both histological subtypes.
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands, Niek.Hugen@radboudumc.nl.
authors.forename: Niek
authors.initials: N
authors.lastname: Hugen
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: Steven L
authors.initials: SL
authors.lastname: Bosch
authors.forename: Jurgen J
authors.initials: JJ
authors.lastname: Fütterer
authors.forename: Marloes A
authors.initials: MA
authors.lastname: Elferink
authors.forename: Corrie A
authors.initials: CA
authors.lastname: Marijnen
authors.forename: Harm J
authors.initials: HJ
authors.lastname: Rutten
authors.forename: Johannes H
authors.initials: JH
authors.lastname: de Wilt
authors.forename: Iris D
authors.initials: ID
authors.lastname: Nagtegaal
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009426:Netherlands; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000628:therapy*; D012042:Registries; D015996:Survival Rate / Q000639:trends