# Swedish Rectal Cancer Trial

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

## TL;DR

The first trial to show that a week of radiotherapy before rectal cancer surgery both halves local recurrence and lets more people live, in the era before total mesorectal excision.

## Summary

The Swedish Rectal Cancer Trial randomised 1,168 patients with resectable rectal cancer to 25 Gy in five fractions before surgery or to surgery alone. Irradiation did not increase postoperative mortality. At five years local recurrence was 11 percent (63 of 553) after radiotherapy against 27 percent (150 of 557) after surgery alone, and overall survival was better in the irradiated group. The control arm's 27 percent local recurrence rate reflects surgery before total mesorectal excision was standardised, which is why the Dutch TME trial repeated the question with quality-controlled surgery and found a smaller absolute gain and no survival difference. The two trials together define what preoperative radiotherapy does: it compensates for imperfect surgery and, once the surgery is good, buys local control rather than life.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-24
- Phase: 3
- Setting: Resectable rectal cancer: 25 Gy in five fractions of preoperative radiotherapy followed by surgery within a week, against surgery alone
- Sponsor: Swedish Rectal Cancer Trial collaborators
- Enrolled: 1168
- Result: Five-year local recurrence 11 against 27 percent, with better overall survival.
- Outcomes: Local recurrence at 5 years: Preoperative 5 x 5 Gy then surgery 11 percent vs Surgery alone 27 percent
- Replication: The Dutch TME trial repeated the question with quality-controlled total mesorectal excision and found local recurrence 2.4 against 8.2 percent with no survival difference.

## Sources

- Swedish Rectal Cancer Trial: improved survival with preoperative radiotherapy in resectable rectal cancer (New England Journal of Medicine 1997): https://doi.org/10.1056/NEJM199704033361402

## 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/)
- trials: [Dutch TME trial](https://onco.cc/trials/dutch-tme-trial/), [Stockholm III](https://onco.cc/trials/stockholm-iii/)

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