Improved survival with preoperative radiotherapy in resectable rectal cancer (Swedish Rectal Cancer Trial)
Needs reviewN = 1,168
- Population
- Patients younger than 80 years with resectable rectal cancer
- Design
- Randomised trial, March 1987 to February 1990: 1168 patients younger than 80 years with resectable rectal cancer were assigned to preoperative irradiation (25 Gy delivered in five fractions in one week) followed by surgery within one week, or to surgery alone. The 2005 follow-up matched patients against three Swedish nationwide registries.
- Arms
- Surgery alone (control): Surgery without preoperative radiotherapy
- Preoperative radiotherapy plus surgery (experimental): 25 Gy in five fractions in one week, then surgery within one week
- People
- Swedish Rectal Cancer Trial, senior author Wilking N, Swedish Rectal Cancer Trial
Δ Local recurrence−16 pointsΔ 60-month OS+10 pointsΔ 108-month Cancer-specific survival+9 pointsΔ Local recurrence−17 pointsΔ OS+8 pointsΔ Cancer-specific survival+10 points
Show the numbers
| Endpoint | Analysis | Preoperative radiotherapy plus surgery | Surgery alone | Effect |
|---|---|---|---|---|
| Local recurrenceRandomised patients included in this analysis (553 in the radiotherapy group, 557 in the surgery-alone group); the abstract does not label the analysis populationRate of local recurrence after five years of follow-up | primarySwedish 1997 | 11% | 27% | P<0.00163 of 553 patients with radiotherapy versus 150 of 557 with surgery alone; the abstract states the difference was found in all subgroups defined by Dukes' stage. |
| OSRandomised patients included in this analysis; the abstract does not label the analysis populationOverall five-year survival rate | primarySwedish 1997 | 58% at 5 y | 48% at 5 y | P=0.004 |
| Cancer-specific survivalPatients treated with curative resectionCancer-specific survival rate at nine years | primarySwedish 1997 | 74% at 9 y | 65% at 9 y | P=0.002 |
| Local recurrencePatients who had curative surgery (454 with radiotherapy, 454 with surgery alone)Local recurrence rate at long-term follow-up (time point not given in the abstract) | long term-updatemedian follow-up 13 yearsFolkesson 2005 | 9% | 26% | P<0.001The abstract states the reduction was seen at all tumour heights but was not statistically significant for tumours more than 10 cm from the anal verge. Follow-up range 3 to 15 years. |
| OSPatients who had curative surgery (454 with radiotherapy, 454 with surgery alone)Overall survival rate at long-term follow-up (time point not given in the abstract) | long term-updatemedian follow-up 13 yearsFolkesson 2005 | 38% | 30% | P=0.008 |
| Cancer-specific survivalPatients who had curative surgery (454 with radiotherapy, 454 with surgery alone)Cancer-specific survival rate at long-term follow-up (time point not given in the abstract) | long term-updatemedian follow-up 13 yearsFolkesson 2005 | 72% | 62% | P=0.03 |
| Endpoint | Analysis | Preoperative radiotherapy plus surgery | Surgery alone | Effect |
|---|---|---|---|---|
| Local recurrenceRandomised patients included in this analysis (553 in the radiotherapy group, 557 in the surgery-alone group); the abstract does not label the analysis populationRate of local recurrence after five years of follow-up | primarySwedish 1997 | 11% | 27% | P<0.00163 of 553 patients with radiotherapy versus 150 of 557 with surgery alone; the abstract states the difference was found in all subgroups defined by Dukes' stage. |
| OSRandomised patients included in this analysis; the abstract does not label the analysis populationOverall five-year survival rate | primarySwedish 1997 | 58% at 5 y | 48% at 5 y | P=0.004 |
| Cancer-specific survivalPatients treated with curative resectionCancer-specific survival rate at nine years | primarySwedish 1997 | 74% at 9 y | 65% at 9 y | P=0.002 |
| Local recurrencePatients who had curative surgery (454 with radiotherapy, 454 with surgery alone)Local recurrence rate at long-term follow-up (time point not given in the abstract) | long term-updatemedian follow-up 13 yearsFolkesson 2005 | 9% | 26% | P<0.001The abstract states the reduction was seen at all tumour heights but was not statistically significant for tumours more than 10 cm from the anal verge. Follow-up range 3 to 15 years. |
| OSPatients who had curative surgery (454 with radiotherapy, 454 with surgery alone)Overall survival rate at long-term follow-up (time point not given in the abstract) | long term-updatemedian follow-up 13 yearsFolkesson 2005 | 38% | 30% | P=0.008 |
| Cancer-specific survivalPatients who had curative surgery (454 with radiotherapy, 454 with surgery alone)Cancer-specific survival rate at long-term follow-up (time point not given in the abstract) | long term-updatemedian follow-up 13 yearsFolkesson 2005 | 72% | 62% | P=0.03 |
Appears in
Sources
Swedish Rectal Cancer Trial, Cedermark B, Dahlberg M, Glimelius B, Påhlman L, Rutqvist LE, Wilking N. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997;336(14):980-7.
Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U. Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005;23(24):5644-50.