Local recurrence is a major problem in rectal cancer treatment.
Preoperative short-term radiotherapy has shown to improve local control and survival in combination with conventional surgery.
Dr Koen Peeters and colleagues investigated the efficacy of preoperative short-term radiotherapy in patients with mobile rectal cancer undergoing total mesorectal excision surgery.
|The 5-year local recurrence risk was 11% with total mesorectal excision alone|
|Annal of Surgery|
The total mesorectal excision trial investigated the value of this regimen in combination with total mesorectal excision.
Long-term results are reported after a median follow-up of 6 years.
The team assessed 1,861 patients with resectable rectal cancer.
The patients were randomized between total mesorectal excision preceded by 5 x 5 Gy or total mesorectal excision alone.
No chemotherapy was allowed, but there was no age limit.
Surgery, radiotherapy, and pathologic examination were standardized.
The team's primary endpoint was local control.
The researchers found that median follow-up of surviving patients was 6 years.
The research team observed that the 5-year local recurrence risk of patients undergoing a macroscopically complete local resection was 6% in case of preoperative radiotherapy.
In patients undergoing total mesorectal excision alone, the 5-year local recurrence risk was 11%.
The researchers found that the overall survival at 5 years was 64% both for preoperative radiotherapy and total mesorectal excision.
The team noted that subgroup analyses showed significant effect of radiotherapy in reducing local recurrence risk for patients with nodal involvement.
There was also a significant effect of radiotherapy on lesions between 5 and 10 cm from the anal verge, and with uninvolved circumferential resection margins.
Dr Peeters' team concluded, "With increasing follow-up, there is a persisting overall effect of preoperative short-term radiotherapy on local control in patients with clinically resectable rectal cancer."
"However, there is no effect on overall survival."
"Since survival is mainly determined by distant metastases, efforts should be directed towards preventing systemic disease."