Outcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study.
BACKGROUND
Radiotherapy and surgery have shown to improve local control and survival in rectal cancer. There are two applied schedules; radiotherapy with a long or short waiting period before surgery. The effect on survival and recurrence of both schedules was studied.


METHODS
All consecutive patients with rectal cancer in the period 2002-2008 were included. Data were gathered on survival, tumour stage, co-morbidity score, and cause of death. The patients were divided in three groups: group 1 patients undergoing surgery without neo-adjuvant radiotherapy; group 2 patients undergoing radiotherapy followed by immediate surgery; and group 3 patients treated with (chemo) radiotherapy followed by a longer waiting period.


RESULTS
A total of 113 patients with rectal cancer underwent surgery. Twenty two patients in group 1, 71 patients in group 2, and 20 in group 3. There was no difference in gender, time to recurrence, co-morbidity score, or causes of death. Fifty percent of patients died due to non-cancer related causes. Mean age in patients of group 3 was significantly lower than in groups 1 and 2 (P=0.02). There was a trend towards a lower tumour stage in the patients of group 3. Overall five year survival was 32% in group 1, 48% in group 2, and 35% in group 3.


CONCLUSIONS
Neo-adjuvant radiotherapy seems to be of benefit in daily practice in patients with rectal cancer. A longer waiting period results in down-staging. Clinicians have to be aware that many patients will die due to other causes than those related to the rectal cancer.
1 Department of Internal Medicine, 2 Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands.
Elmer E
EE
van Eeghen
1 Department of Internal Medicine, 2 Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands.
Frank
F
den Boer
1 Department of Internal Medicine, 2 Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands.
Sandra D
SD
Bakker
1 Department of Internal Medicine, 2 Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands.
Ruud J L F
RJ
Loffeld
Charlson score; Rectal cancer; co-morbidity; radiotherapy; recurrence; survival