Dutch TME trial

The Dutch TME trial randomised 1,861 patients with resectable rectal cancer to 5 x 5 Gy preoperative radiotherapy followed by total mesorectal excision, or to total mesorectal excision alone, with surgical quality controlled by training and pathology review. Among the 1,748 who had a macroscopically complete local resection, local recurrence at two years was 2.4 percent with radiotherapy against 8.2 percent without. Two-year overall survival was the same (82.0 against 81.8 percent). The trial settled two questions at once: total mesorectal excision is the operation, and radiotherapy reduces local recurrence without lengthening life, so its use is a trade against long-term bowel and sexual function.