Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer

This randomized trial compared preoperative with postoperative chemoradiotherapy for locally advanced rectal cancer. Overall survival was similar in the two groups, but patients assigned to preoperative chemoradiotherapy had lower rates of local recurrence and fewer long-term toxic effects than patients in the postoperative group. In this trial of nearly 800 patients, those assigned to preoperative chemoradiotherapy had lower rates of local recurrence and fewer toxic effects. Adjuvant radiotherapy with or without chemotherapy has been used widely to improve outcomes in patients with rectal cancer. For locally advanced disease, postoperative chemoradiotherapy significantly improves both local control and overall survival as compared with surgery alone or surgery plus irradiation. 1 , 2 This information prompted a National Institutes of Health consensus conference, convened in 1990, to recommend postoperative adjuvant chemoradiotherapy as standard treatment for patients with rectal cancer classified as tumor–node–metastasis (TNM) stage II (i.e., a tumor penetrating the rectal wall, without regional lymph-node involvement) or stage III (i.e., any tumor with regional lymph-node involvement). 3 Several randomized studies have found . . .