Initial report from a Swedish multicentre study examining the role of preoperative irradiation in the treatment of patients with resectable rectal carcinoma. Swedish Rectal Cancer Trial

Abstract

Between March 1987 and February 1990, 1168 patients with resectable rectal cancer were recruited into a nationwide Swedish trial. Patients were randomly allocated to receive either preoperative irradiation (25 Gy in five fractions over 1 week) followed by surgery within 1 week, or surgery alone. In each group 454 patients underwent curative surgery. The groups were well matched for age, sex and surgical procedure. The postoperative mortality rates did not differ: 4 per cent after irradiation versus 3 per cent after surgery alone, but the postoperative mortality rate was significantly higher in patients treated with a two- rather than three- or four-portal technique (15 versus 3 per cent, P < 0.001). More perineal wound infections were found in patients receiving irradiation (20 versus 10 per cent, P < 0.001). No difference in the incidence of anastomotic dehiscence or other postoperative complication was found between the groups. Preoperative radiotherapy with a short-term high-dose technique can be delivered without major acute adverse effects, provided the irradiation technique is optimized.