Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. Mesorectal excision for rectal cancer Adjuvant preoperative radiotherapy in patients with rectal carcinoma: Adverse effects during long term follow‐up of two randomized trials Preoperative or postoperative irradiation in adenocarcinoma of the rectum: Final treatment results of a randomized trial and an evaluation of late secondary effects Preoperative irradiation in operable cancer of the rectum: report of the Toronto trial. The Long‐Term Effect of Adjuvant Postoperative Chemoradiotherapy for Rectal Carcinoma on Bowel Function [Delayed toxicity of brief preoperative irradiation and risk-adjusted postoperative radiotherapy of operative rectal carcinoma. Results of a randomized prospective study]. Preoperative radiation and surgery for cancer of the rectum: Veterans administration surgical oncology group trial II Preoperative irradiation affects functional results after surgery for rectal cancer Preoperative Radiotherapy as Adjuvant Treatment in Rectal Cancer: Final Results of a Randomized Study of the European Organization for Research and Treatment of Cancer (EORTC) Pre- or postoperative radiotherapy in rectal and rectosigmoid carcinoma. Report from a randomized multicenter trial. Adjuvant preoperative radiotherapy for locally advanced rectal carcinoma Long-term results of a randomised trial of short-course low-dose adjuvant pre-operative radiotherapy for rectal cancer: reduction in local treatment failure. Preoperative Radiotherapy for colorectal Cancer Evaluation of Preoperative Radiation Therapy in Operable Colorectal Cancer The evaluation of low dose pre‐operative X‐ray therapy in the management of operable rectal cancer; results of a randomly controlled trial Local recurrence of rectal cancer following preoperative irradiation. Preoperative short‐term radiation therapy in operable rectal carcinoma: A prospective randomized trial Five-year results of a prospective and randomized study: experience with combined radiotherapy and surgery of primary rectal carcinoma. Preoperative irradiation of rectosigmoid carcinoma including its regional lymph nodes. Improved survival with preoperative radiotherapy in resectable rectal cancer.
PURPOSE The optimal timing of surgery after preoperative radiotherapy in rectal cancer is unknown . The aim of this trial was to evaluate the role of the interval between preoperative radiotherapy and surgery . PATIENTS AND METHODS Patients with rectal carcinoma accessible to rectal digital examination , staged T2 to T3 , NX , M0 , were r and omized before radiotherapy ( 39 Gy in 13 fractions ) into two groups : in the short interval ( SI ) group , surgery had to be performed within 2 weeks after completion of radiation therapy , compared with 6 to 8 weeks in the long interval ( LI ) group . Between 1991 and 1995 , 201 patients were enrolled onto the study . RESULTS A long interval between preoperative radiotherapy and surgery was associated with a significantly better clinical tumor response ( 53 . 1 % in the SI group v 71.7 % in the LI group , P = .007 ) and pathologic downstaging ( 10.3 % in the SI group v 26 % in the LI group , P = .005 ) . At a median follow-up of 33 months , there were no differences in morbidity , local relapse , and short-term survival between the two groups . Sphincter-preserving surgery was performed in 76 % of cases in the LI group versus 68 % in the SI group ( P = 0.27 ) . CONCLUSION A long interval between preoperative irradiation and surgery provides increased tumor downstaging with no detrimental effect on toxicity and early clinical results . When sphincter preservation is question able , a long interval may increase the chance of a successful sphincter-saving surgery A series of 103 consecutive rectal cancers was prospect ively documented . Laparotomy was performed in 78 patients of whom five did not undergo resection . Resection was considered curative unless there were liver metastases or biopsy‐proven residual disease . Nine patients had a palliative resection . Thus 64 patients underwent a curative resection , 52 ( 81 per cent ) of whom had an anterior resection of which 26 ( 46 per cent ) were performed by trainees . There were three deaths after operation . Eight ( 14 per cent ) patients developed a clinical anastomotic leak . Thirty patients were available for a minimum follow‐up of 24 ( mean 33 , range 24–49 ) months . Four ( 13 per cent ) patients developed distant recurrence . There were no isolated pelvic or anastomotic recurrences . One patient with distal recurrence may have had pelvic disease . The cumulative recurrence – free survival rate at 24 months was 84 per cent . These results support the suggestion that mesorectal excision may reduce local recurrence Adjuvant preoperative radiotherapy of patients with primary rectal carcinoma improves local control and survival , but also may increase the risk of early postoperative morbidity and mortality . In addition , the possible late adverse effects of this treatment are largely unknown From 1980 to 1985 , 471 patients with resectable rectal and rectosigmoid cancer were r and omly allocated to receive either preoperative short-term high-dose irradiation ( 25.5 Gy in one week ) for all patients or prolonged postoperative radiotherapy ( 60 Gy in seven to eight weeks ) only for patients with a Dukes B or C lesion . After a minimum follow-up of five years , the local recurrence rate was statistically significantly lower after preoperative than after postoperative radiotherapy ( 13 percentvs.22 percent;P=0.02 ) . No difference in overall survival was noted ( P=0.5 ) . To evaluate possible late side effects on the bowel , urinary bladder , or skin after surgery and additional preoperative or postoperative radiotherapy , all patients included in the r and omized trial , together with 58 patients from a preceding pilot study with the same preoperative regimen , were studied in a prolonged follow-up program . The hospital files of all patients were re-examined . Of the patients who were carefully examined , 176 had a survival exceeding five years and 19 had a survival exceeding 10 years . Overall , 7 percent ( 33/ 464 ) either were operated upon or have had a radiologic diagnosis of small bowel obstruction : 14/255 ( 5 percent ) after preoperative irradiation , 14/127 ( 11 percent ) after postoperative irradiation , and 5/82 ( 6 percent ) after surgery alone . The cumulative risk of developing a bowel obstruction was significantly increased after postoperative radiotherapy . Among the 98 patients alive after preoperative irradiation , significant morbidity from the bowel was noted in 11 patients , from the urinary bladder in two , and from the skin in six . In the postoperatively treated group of 34 patients , the bowel , urinary bladder , and skin morbidity were significant in five , two , and five patients , respectively . Corresponding morbidity in 44 nonirradiated patients was seen in five , one , and two patients , respectively . It is concluded that preoperative , short-term , high-dose radiotherapy decreases the local recurrence rate relative to postoperative radiotherapy , with no indications of increased late morbidity after a follow-up of 5 to 10 years The authors have studied the value of preoperative radiotherapy in 125 patients with cancer of the rectum . The patients were divided into two groups , control ( no irradiation ) and experimental ( irradiation ) , and according to Dukes ' pathological stage . The crude survival indicated no difference between the two groups , but analysis by stage and group demonstrated that for patients with a Dukes ' stage C lesion , 500 rads of cobalt-60 gamma irradiation a few hours before excision of the lesion approximately doubles the probability of survival at 5 years . The prospect of surgical cure is three times higher in cancers arising above the peritoneal reflection than in those arising below it . If the practice of abdominoperineal resection is to continue the authors recommend that preoperative irradiation become a routine procedure Objective The authors assessed the long-term effect of postoperative chemoradiotherapy on bowel function . Summary Background Data Adjuvant postoperative radiation therapy , often combined with chemotherapy , is being used increasingly often for rectal carcinoma . However , the long-term effect of this treatment on bowel function has not been investigated . Methods The records were review ed of all patients undergoing anterior resection for rectal carcinoma 2 to 5 years previously . During this period , patients with Astler-Coller stage B2 or C tumors generally were given postoperative radiation therapy with chemotherapy , whereas those with earlier stage tumors were not . To minimize possible confounding factors that may have been more common in the group receiving chemoradiotherapy and that may affect bowel function , extensive exclusion criteria were used , such as invasion of contiguous organs , local or distant metastases , use of a dysfunctfoning stoma , and anastomotic or pelvic complications . One hundred remaining patients were suitable for inclusion in the study and participated in a telephone question naire ; 41 patients had postoperative chemoradiotherapy , and 59 did not . Results The two groups were well matched for sex , level of anastomosis , and length of follow-up , although the group receiving chemoradiotherapy was slightly younger . The group that had chemoradiotherapy had more bowel movements per day than the group that did not have radiation therapy ( median 7 vs. median 2 , p < 0.001 ) ; the former group had “ clustering ” of bowel movements more often ( 42 % vs. 3 % , p < 0.001 ) , had nighttime movements more often ( 46 % vs. 14 % , p < 0.001 ) , had occasional or frequent incontinence more often ( 39 % and 17 % vs. 7 % and 0 % , p < 0.001 ) , wore a pad more often ( 41 % vs. 10 % , p < 0.001 ) , and were unable to defer defecation for more than 15 minutes more often ( 78 % vs. 19 % , p < 0.001 ) . The group that had chemoradiotherapy also had stool of liquid consistency , used antidiarrheal medications , had perianal skin irritation , were unable to differentiate stool from gas , and needed to defecate again within 30 minutes of a movement significantly more often than the group that did not receive chemoradiotherapy AIM Analysis of a r and omized study of preoperative radiation therapy for operable carcinoma of the rectum with regard to late sequelae . Results of tumor control and survival , which have already been published in detail are summarized for comparison and for confirmation of the conclusions . PATIENTS AND METHODS Between January 1988 and October 1993 94 patients with operable carcinoma of the rectum were included in a r and omized trial . Fourty-seven patients were treated with 5 x 3.3 Gy ( field size 16 x 16 cm , 9 MeV photons ) 24 to 48 hours prior to surgery ; 46 patients did not receive preoperative irradiation .  If risk factors ( T4-stage , R1/R2 resection , intraoperative tumor perforation ) were present , postoperative irradiation was performed after CT-planning . Total postoperative doses of 41.4 Gy ( preoperative irradiation ) or 59.8 Gy ( surgery only ) were applied with doses per fraction of 1.8 to 2.0 Gy . Local control , survival , and pattern of side effects were analyzed at 5 years after conclusion of the trial . RESULTS The frequency of local recurrence was markedly reduced by preoperative irradiation of R0-resected patients ( 24 % vs 13 % , p = 0.08 ) . The time to recurrence was delayed ( 1.9 vs 3 years ) . The 5-year actuarial survival rate was significantly higher in the preoperatively irradiated group compared to the not pre-irradiated group ( 40 % vs 28 % , p = 0.027 ) . Multivariate analysis revealed UICC-grading as the only independent parameter for local control ( p = 0.0003 ) , while preoperative irradiation ( p = 0.07 ) and T-stage ( p = 0.08 ) only displayed a trend . For patient survival , age ( p = 0.0003 ) . R-status ( p = 0.01 ) and UICC-score ( p = 0.001 ) were significant prognostic factors . Preoperative irradiation  had a non-significant effect only ( p = 0.078 ) . Radiation-induced side effects with a LENT-SOMA score > 2 were observed neither during frequent follow-up nor at an additional examination of those patients still alive in 1998 ( n = 25 ) . Of 4 pre- and postoperatively irradiated patients with risk factors , 3 had side effects grade 1 or 2 , predominantly rectal changes , at 5 to 11 years after treatment . CONCLUSIONS A positive effect on tumor control and survival is achieved with preoperative irradiation with the doses used in this study , with moderate side effects In a prospect i ve r and omized trial , 361 male patients with histologically proven adenocarcinoma of the rectum , judged preoperatively to require abdominoperineal resection ( APR ) , were treated by surgery alone or were given 3,150 rads of preoperative radiotherapy . Surgical resection was done on 320 patients , 262 having “ curative ” APR . Only moderate symptoms from radiotherapy were noted and postoperative complications and 30‐day mortality were similar in both groups . Five‐year survival for curative APR was the same in both groups ( 50 % for both treated and control patients ) . The incidence of positive lymph nodes in the resected specimens was 35 % in treated and 41 % in controls . In the first preoperative radiotherapy trial conducted by the group , 5‐year survival in patients undergoing “ curative ” APR was 47 % in treated versus 34 % in control groups . Additionally , the difference in positive lymph nodes in the resected specimens was substantially greater in the first trial ( 26 % in treated versus 44 % in controls ) . Cancer 58:352–359 , 1986 PURPOSE : The Swedish Rectal Cancer Trial has unequivocally demonstrated that preoperative high-dose ( 5 × 5 Gy ) radiotherapy reduces local failure rates and improves overall survival . This will have an impact on the primary treatment of rectal cancer . This study investigates the effect of preoperative high-dose radiotherapy on long-term bowel function in patients treated with anterior resection .  METHODS : A question naire was answered by 92 percent ( 203/220 ) of patients who were included in the Swedish Rectal Cancer Trial and who were alive after a minimum of five years . Thirty-two patients were excluded , mainly because of postoperative stomas and dementia , which left 171 for analysis . RESULTS : Median bowel frequency per week was 20 in the irradiated group ( n=84 ) and 10 in the surgery-alone group ( n=87;P<0.001 ) . Incontinence for loose stools ( P<0.001 ) , urgency ( P<0.001 ) , and emptying difficulties ( P<0.05 ) were all more common after irradiation . Sensory functions such as “ discrimination between gas and stool ” and “ ability to safely release flatus ” did not , however , differ between groups . Thirty percent of the irradiated group stated that they had an impaired social life because of bowel dysfunction , compared with 10 percent of the surgery-alone group ( P<0.01 ) . CONCLUSIONS : The study indicates that high-dose radiotherapy  influences long-term bowel function , thus emphasizing the need for finding predictive factors for local recurrence to exclude patients with a very high probability for cure with surgery alone and to use optimized radiation techniques A r and omized clinical trial was conducted by the European Organization for Research and Treatment for Cancer ( EORTC ) Gastrointestinal Cancer Cooperative Group to study the effectiveness of irradiation therapy administered in a dosage of 34.5 Gy , divided into 15 daily doses of 2.3 Gy each before radical surgery for rectal cancer ( T2 , T3 , T4 , NX , MO ) . Four hundred sixty-six patients were entered in the clinical trial between June 1976 and September 1981 .  Tolerance and side effects of pre- operative irradiation were acceptable . The overall 5-year survival rates were similar in both groups . When considering only the 341 patients treated by surgery with a curative aim , the 5-year survival rates were 59.1 % and 69.1 % in the control group and in the combined modality group , respectively ( p = 0.08 ) . The local recurrence rates at 5 years were 30 % and 15 % in the control group and the adjuvant radiotherapy group , respectively ( p = 0.003 ) . Although this study did not show preoperative radiotherapy to have a statistically significant benefit on overall survival , it does have a clear effect on local control of rectal cancer . Therefore , before performing radical surgery , this adjuvant therapy should be administered to patients who have locally extended rectal cancer Between October 1980 and December 1985 , 471 patients with a resectable rectal carcinoma entered a r and omized multicenter trial for comparison of pre- and postoperative irradiation . Two hundred thirty-six patients were allocated to receive high-dose fractionated preoperative irradiation ( total dosage , 25.5 Gy in five to seven days ) and 235 patients to receive postoperative irradiation to a very high dosage level with conventional fractionation ( 60 Gy in a total 8 weeks ) . The postoperative treatment was delivered only to a high-risk group of patients ( Astler-Coller stages B2 , C1 , and C2 ) . The preoperative irradiation was well tolerated , with no immediate irradiation-related complications and no increased postoperative mortality ( 3 % , 7 of 217 patients , compared to 5 % , 10 of 215 patients in the postoperatively irradiated group ) . More patients in the preoperative irradiation group had perineal wound sepsis after abdominoperineal resection and this prolonged the stay in hospital after surgery . In 50 % of the patients the postoperative treatment could not be commenced until more than 6 weeks after surgery . The postoperative treatment was not as well tolerated as the preoperative one . The local recurrence rate was statistically significantly lower after preoperative than after postoperative radiotherapy ( 12 % versus 21 % ; p = 0.02 ) . In both groups more patients developed a local recurrence if the bowel was perforated at surgery or if the resection line was microscopically close to the tumor . To date , with a minimum follow-up of 3 years and a mean follow-up of 6 years , there is no difference in survival rates between the two groups PURPOSE : A prospect i ve , r and omized clinical trial was conducted by the Northwest Rectal Cancer Group to study the effects of preoperative radiotherapy given one week before surgery in locally advanced ( tethered or fixed ) rectal carcinoma . METHODS : A total of 284 patients were entered into the trial between 1982 and 1986 ; 141 were allocated to receive surgical treatment alone , and 143 were allocated to receive preoperative radiotherapy .  A 10 × 10 × 10 cm volume in the posterior pelvis , centered on the tumor , was irradiated at a dose of 20 Gy , divided into four daily fractions of 5 Gy each . RESULTS : No differences were observed in any of the clinicopathologic variables in the two arms of the trial ; there were no striking down-staging effects in the irradiated tumors . After a minimum follow-up period of 96 months , the overall and cancer-related mortality rates were similar in both arms of the study ( P = 0.21 and P = 0.09 , respectively ) . There was a highly significant reduction in local recurrences in the irradiated group ( 12.8 percent x-ray therapyvs . 36.5 percent surgery;P = 0.0001 ) . The majority of local recurrences after preoperative radiotherapy occurred inside the radiotherapy field ( 10 cases ; 7 percent ) , with only six cases ( 5 percent ) outside the field . No significant difference was observed in the rates of distant metastasis between the two treatment groups ( P = 0.73 ) . CONCLUSIONS : Although there is no statistically significant survival benefit in the whole series , there is a survival benefit for the subset of patients considered by the surgeon to have undergone a curative operation . We recommend that this form of adjuvant therapy should be offered to all patients with locally advanced rectal cancer who are to undergo radical surgery A prospect i ve r and omised multicentre trial compared pre-operative radiotherapy followed by surgery with surgery alone for rectal cancer < or = 12 cm from the anal verge . Of 468 patients ( mean age 67 years , range 31 - 94 , 273 males ) who met the entry criteria , 228 were r and omised to radiotherapy ( 3 x 5 Gy over 5 days within 2 days of operation ) followed by surgery , and 239 to surgery alone .  R and omisation was unknown in 1 patient . Follow-up to death or 5 years was achieved in 454 ( 97 % ) patients . 31 ( 7 % ) of the 468 patients died within 30 days of operation ( radiotherapy and surgery 21 [ 9 % ] , surgery alone 10 [ 4 % ] ; P < 0.05 ) . Cardiovascular and thromboembolic complications were more common after radiotherapy and surgery ( 30 , 13 % ) than after surgery alone ( 8 , 3 % ; P < 0.005 ) . Of the 280 patients who had curative surgery  , 52 % of those who had radiotherapy and surgery and 56 % of those who had surgery alone survived 5 years ( P = 0.88 ) . 395 patients attended out patients clinics at least once . Local treatment failure was identified during follow-up in 82 patients [ 31/185 ( 17 % ) radiotherapy and surgery ; 51/210 ( 24 % ) surgery alone ; P < 0.05 ] . It occurred in 33 of the 258 patients who had a curative resection and attended out patients [ radiotherapy and surgery , 11/120 ( 9 % ) , surgery alone , 22/138 ( 16 % ) ; P = 0.08 ] . Long-term survival was unaffected , but long-term local recurrence was reduced by the addition of low-dose radiotherapy to surgery . Peri-operative mortality was , however , increased In a prospect i ve r and omized trial , 700 patients with a confirmed histological diagnosis of adenocarcinoma of the rectum or rectosigmoid were r and omized to receive radiotherapy prior to operation ( 2000 to 2500 rads in two weeks ) or surgery alone .  Five year observed survival in the 453 patients on whom " curative " resection was possible was 48.5 % in the X-ray treated group compared with 38.8 % in controls , while in the 305 having low lying lesions requiring abdominoperineal resection , survival in the treated group was 46.9 % compared with 34.3 % in controls . Although suggestive of a treatment benefit , neither is considered statistically significant . Histologically positive lymph nodes were found in 41.2 % of the control group and in only 27.8 % of the patients receiving radiotherapy . Reveiw of all patients who died during the study shows a consistently lower death rate from cancer in the radiotherapy group . Although this study suggests a treatment benefit from preoperative radiotherapy , further studies now in progress by this group and others are necessary to determine the optimal dose regimen Material s and Methods Patients with operable colorectal cancer in the ascending colon , descending colon , and rectum were r and omized to 500 cGy before definitive surgery .  Patients with stage A and B1 lesions received no further treatment .  All patients with stage B2 , B3 , C1 , C2 , and C3 received a minimum of 4500 cGy postoperatively . Results Three hundred fifty-three patients were registered for the study . Three hundred one patients were available for analyses . Folow-up was a minimum of 5 years on all study patients . The majority of patients had rectal cancer .  Complications of treatment were acceptable . Two hundred thirty-one patents had stage B2 , B3 , C1 , C2 , or C3 tumors . Estimated 5-year rates for no preoperative therapy versus preoperative therapy were as follows : local recurrence 29 % versus 26 % ; metastasis 41 % versus 43 % ; and survival 54 % versus 54 % . No statistical benefit was observed for preoperative treatment . Conclusions In a prospect i ve r and omized trial design ed to test the value of low-dose preoperative irradiation followed by surgery and postoperative irradiation , the authors were unable to observe any benefit to low-dose preoperative therapy in patients with unfavorable stages 824 patients with operable rectal carcinoma were r and omly allocated to be treated by surgery alone , 2000 rad in 10 daily fractions and 500 rad as a single fraction . No difference has been demonstrated in the actuarial survival rates to 5 years . The local recurrence‐free and metastasis‐free rates are similar in all groups . There is also no evidence that the pre‐operative radiotherapy benefited patients in subgroups by Dukes ' stage . The complication rates were also similar in the three treatment groups The authors investigated  local recurrence of rectal cancer in patients ' groups preoperatively irradiated ( 40 - 50 Gy ) or treated by surgery alone .  In advanced disease both treatment groups were administered postoperative chemotherapy , too . Local recurrence was observed in 30.2 % in patients treated by surgery alone  , while it dropped to 11.65 % in the patients ' group subjected to radiation therapy prior to surgery  ( p < 0.05 ) . Impairment of degree of differentiation result ed in an enhanced number of recurrences in both groups , even if they appeared later in irradiated patients From 1980 to 1987 , 849 patients with clinical ly resectable rectal adenocarcinoma were r and omized into a controlled clinical trial of radiation therapy ( 2500 cGy over 5 to 7 days ) before surgery versus surgery alone . At a median follow‐up time of 53 months ( range , 8 to 90 ) the incidence of pelvic recurrence among 679 curatively operated upon patients was significantly lower among those allocated to radiation therapy ( P < 0.01 ) . A reduction was observed in all Dukes ' stages . No significant difference between the treatment groups was observed with regard to frequency of distant metastases or overall survival . Among all r and omized patients as well as the radically operated patients the recurrence‐free interval , i.e. , time to local recurrence or distant metastasis , was significantly prolonged in the preoperatively irradiated group . The radically operated patients also had a significantly prolonged survival related to rectal cancer ( P = 0.05 ) The postoperative morbidity , however , was significantly higher among irradiated patients . The postoperative mortality was 8 % in the radiation therapy group compared to 2 % in the surgery alone group ( P < 0.01 ) In the past three decades there have been many reports dealing with different radio-therapeutic approaches , in combination with surgery , intended to improve the survival rates of patients with potentially curable rectal carcinoma . However , no clear-cut data have yet been presented in this field of clinical investigation , especially with respect to whether pre- or postoperative radiation should be applied and which kind of fractionation or dosage should be given Part of Symposium : Multidiscipline Approach to  Colorectal Cancer .  Moderator , Morton M. Kligerman , M.D. , New Haven , Connecticut . From the Departments of Radiology and Pathology , Yale University School of Medicine and the Radiological Service of the YaleNew Haven Hospital , New Haven , Connecticut . Supported in part by USPHS National Cancer Institute Grant No. CA 06519 . t Chief of Radiotherapy and Nuclear Medicine Department , Faculty of Medicine , Universidad Central , Caracas , Venezuela . MARCH , BACKGROUND Adjuvant radiotherapy for rectal cancer has been extensively studied , but no trial has unequivocally demonstrated improved overall survival with radiotherapy , despite a reduction in the rate of local recurrence . METHODS Between March 1987 and February 1990 , we r and omly assigned 1168 patients younger than 80 years of age who had resectable rectal cancer to undergo preoperative irradiation ( 25 Gy delivered in five fractions in one week ) followed by surgery within one week or to have surgery alone .  RESULTS The irradiation did not increase postoperative mortality . After five years of follow-up , the rate of local recurrence was 11 percent ( 63 of 553 patients ) in the group that received radiotherapy before surgery and 27 percent ( 150 of 557 ) in the group treated with surgery alone ( P<0.001 ) . This difference was found in all subgroups defined according to Dukes ' stage . The overall five-year survival rate was 58 percent in the radiotherapy-plus-surgery group and 48 percent in the surgery-alone group ( P=0.004 ) . The cancer-specific survival rates at nine years among patients treated with curative resection were 74 percent and 65 percent , respectively ( P=0.002 ) . CONCLUSIONS A short-term regimen of high-dose preoperative radiotherapy reduces rates of local recurrence and improves survival among patients with resectable rectal cancer
Background This systematic review with meta- analysis was design ed to evaluate the literature and to develop recommendations regarding the use of preoperative radiotherapy in the management of patients with resectable rectal cancer .