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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.
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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
1,168 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Local recurrence at 5 yearsprimary | Preoperative 5 x 5 Gy then surgery | 553 | 11 percent | - | - | link |
| Surgery alone | 557 | 27 percent |
Shares Dutch TME trial, Stockholm III, IMRT / IGRT (modern external beam), Rectal cancer.
Shares Dutch TME trial, Stockholm III, IMRT / IGRT (modern external beam), Rectal cancer.
Shares Stockholm III, IMRT / IGRT (modern external beam), Rectal cancer, Colorectal cancer.
Shares Dutch TME trial, IMRT / IGRT (modern external beam), Rectal cancer, Colorectal cancer.