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Randomized study on preoperative radiotherapy in rectal carcinoma

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Abstract

Background: A population based prospective randomized trial on preoperative radiotherapy in operable rectal cancer was conducted in Stockholm, Sweden. Five hundred fifty-seven patients from 12 institutions were included with histologically proven, clinically resectable rectal adenocarcinoma. Patients planned for local excision or previously irradiated to the pelvis were excluded.

Methods: A total of 272 patients were allocated to preoperative irradiation with 25 Gy in five cycles during 5–7 days to the rectum and the pararectal tissues (RT+ group) and 285 patients were allocated to surgery only (RT− group). The median follow-up time was 50 months. No patient was lost to follow-up. Surgery was considered curative in 479 patients (86%).

Results: Locoregional recurrence occurred in 10% of the patients in the RT+ group versus 21% in the RT− group (p<0.01). Among the curatively operated patients, distant metastases occurred in 19% in the RT+ group versus 26% in the RT− group (p=0.02). The overall survival was improved in the irradiated patients (p=0.02). Postoperative complications were more common after irradiation but were usually mild. The postoperative mortality was low in both groups.

Conclusion: Preoperative short-term, high-dose radiotherapy as given in this trial reduces the risk of local and distant recurrence and improves survival after curative surgery for rectal carcinoma.

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Authors and Affiliations

  1. The Oncologic Centre, Karolinska Hospital, Stockholm, Sweden

    B. Cedermark

Authors
  1. B. Cedermark
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Stockholm Colorectal Cancer Study Group

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Writing Committee of the Stockholm Colorectal Cancer Study Group: Björn Cedermark, MD (study chairman), Department of Surgery, Karolinska Hospital; Hemming Johansson, BA, The Oncologic Centre, Karolinska Hospital; Lars E. Rutqvist, MD, The Oncologic Centre, Karolinska Hospital; Nils Wilking, MD, Department of Oncology, Karolinska Hospital, Stockholm, Sweden.

Study Group: Mats Broberg, MD, Claes Johansson, MD, Danderyds Hospital; Sven Goldman, MD, Leif Åkerud, MD, Ersta Hospital; Bo Brismar, MD, Staffan Ewerth, MD, Huddinge Hospital; Göran Lundell, MD, Carlos Rubio, MD, Tongpleaw Singnomklao, Åke Öst, MD, Karolinska Hospital; Sven O. Svensson, MD, Löwenströmska Hospital; György Fenyö, MD, Nacka Hospital; Lars Eriksson, MD, Bo Hellström, MD, Norrtälje Hospital; Christer Lindholmer, MD, Tolle Theve, MD, Sabbatsbergs Hospital; Johan Dalén, MD, S:t Görans Hospital; Inger Magnusson, MD, Åke Rieger, MD, Christer Svensson, MD, Södersjukhuset; Ulf Öhman, MD, Södertälje Hospital; Staffan Bark, MD, Magnus Sundblad, MD, Visby Hospital.

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Stockholm Colorectal Cancer Study Group., Cedermark, B. Randomized study on preoperative radiotherapy in rectal carcinoma. Annals of Surgical Oncology 3, 423–430 (1996). https://doi.org/10.1007/BF02305759

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  • DOI: https://doi.org/10.1007/BF02305759

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