Marked improvements in survival of patients with rectal cancer in the Netherlands following changes in therapy, 1989–2006

Abstract Background Since the 1990s, treatment of patients with rectal cancer has changed in the Netherlands. Aim of this study was to describe these changes in treatment over time and to evaluate their effects on survival. Methods All patients in the Netherlands Cancer Registry with invasive primary rectal cancer diagnosed during the period 1989–2006 were selected. The Cochran–Armitage trend test was used to analyse trends in treatment over time. Multivariate relative survival analyses were performed to estimate relative excess risk (RER) of dying. Results In total, 40,888 patients were diagnosed with rectal cancer during the period 1989–2006. The proportion of patients with stages II and III disease receiving preoperative radiotherapy increased from 1% in the period 1989–1992 to 68% in the period 2004–2006 for younger patients (