# Stockholm III

Source: https://onco.cc/trials/stockholm-iii/  
OnCo record `stockholm-iii` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Waiting four to eight weeks after a short course of radiotherapy is as safe as operating immediately, and it gives time for the tumour to shrink.

## Summary

Stockholm III randomised 840 patients from eighteen Swedish hospitals between short-course radiotherapy with immediate surgery, short-course radiotherapy with surgery delayed four to eight weeks, and long-course radiotherapy with delayed surgery. Local recurrence occurred in eight of 357, ten of 355 and seven of 128 patients respectively; both delayed arms were non-inferior (hazard ratio for short-course with delay 1.44, 95% CI 0.41 to 5.11; for long-course with delay 2.24, 0.71 to 7.10; p=0.48). Postoperative complications were fewer with delay. The trial made the delayed short course a legitimate option, which is what RAPIDO and STELLAR then built their total neoadjuvant schedules on and what allows organ preservation after a one-week course.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-24
- Registry id: NCT00904813
- Phase: 3
- Setting: Resectable rectal cancer: 5 x 5 Gy with surgery within a week, 5 x 5 Gy with surgery after four to eight weeks, or 25 x 2 Gy with delayed surgery
- Sponsor: Karolinska Institutet
- Enrolled: 840
- Result: Delaying surgery after 5 x 5 Gy is non-inferior for local recurrence and has fewer postoperative complications.
- Outcomes: Local recurrence: Short-course, immediate surgery 8 events vs Short-course, delayed surgery 10 events vs Long-course, delayed surgery 7 events

## Sources

- ClinicalTrials.gov NCT00904813: https://clinicaltrials.gov/study/NCT00904813
- Stockholm III: optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Lancet Oncology 2017): https://doi.org/10.1016/S1470-2045(17)30086-4

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- institutions: [Karolinska University Hospital](https://onco.cc/institutions/karolinska/)
- trials: [CAO/ARO/AIO-94 (German Rectal Cancer Study)](https://onco.cc/trials/cao-aro-aio-94/), [Dutch TME trial](https://onco.cc/trials/dutch-tme-trial/), [RAPIDO](https://onco.cc/trials/rapido/), [STELLAR (rectal cancer)](https://onco.cc/trials/stellar-rectal/), [Swedish Rectal Cancer Trial](https://onco.cc/trials/swedish-rectal-cancer-trial/)

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