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The trial that asked whether radiotherapy still helps once the surgery is done properly. It does for local control, cutting two-year pelvic recurrence from 8.2 to 2.4 percent, but it did not lengthen life.
Kapiteijn, Marijnen, Nagtegaal and colleagues randomly assigned 1,861 patients with resectable rectal cancer to preoperative radiotherapy (5 Gy on each of five days) followed by total mesorectal excision, or to total mesorectal excision alone, with standardisation and quality control of the radiotherapy, the surgery and the pathological assessment. Of these, 1,805 were eligible and 1,748 underwent a macroscopically complete local resection.
The overall two-year survival was identical in the two groups, and the trial therefore separated local control from survival in rectal cancer for the first time.
The modern basis for offering short-course radiotherapy selectively: it buys local control, not survival, so the decision turns on the predicted recurrence risk from MRI against the long-term bowel and sexual morbidity of pelvic irradiation.
The trial that made preoperative rather than postoperative radiotherapy the UK standard, and the one whose circumferential resection margin pathology protocol, led by Quirke, became the quality measure for rectal surgery worldwide.
This trial made preoperative chemoradiotherapy the standard for locally advanced rectal cancer worldwide and is the foundation on which total neoadjuvant therapy and watch-and-wait organ preservation were later built.
The origin of short-course preoperative radiotherapy, still the standard schedule across northern Europe and the backbone of the RAPIDO regimen 24 years later.
The single largest improvement in rectal cancer outcomes came from a change in surgical technique, not a drug. Every radiotherapy trial since has had to show it adds something on top of a properly performed total mesorectal excision.
Shares Cornelis J. H. van de Velde, Total mesorectal excision (TME), Radiotherapy, Surgery and radiotherapy cure most, get least and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Neoadjuvant / adjuvant / perioperative, MRI and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Surgery and radiotherapy cure most, get least, MRI and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Surgery and radiotherapy cure most, get least, MRI and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, IMRT / IGRT (modern external beam) and the tag colorectal-evidence.
Shares Radiotherapy, Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Toxicity and quality of life are undervalued and the tag colorectal-evidence.
Shares Neoadjuvant / adjuvant / perioperative, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, New England Journal of Medicine, Colorectal cancer and the tag colorectal-evidence.
Shares Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Toxicity and quality of life are undervalued, New England Journal of Medicine and the tag colorectal-evidence.