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Radiother Oncol. 2017 Jun;123(3):446-453. doi: 10.1016/j.radonc.2017.04.012. Epub 2017 May 5.

Preoperative chemoradiotherapy for rectal cancer and impact on outcomes - A population-based study.

Author information

1
Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway. Electronic address: linn.merete.asli@kreftregisteret.no.
2
Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
3
Division of Surgery, Inflammatory Diseases, and Transplantation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
4
Department of Oncology and K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway.

Abstract

BACKGROUND AND PURPOSE:

Preoperative (chemo)radiotherapy ((C)RT) for rectal cancer is, in Norway, restricted to patients with cT4-stage or threatened circumferential resection margin. This nationwide population-based study assessed the use of preoperative (C)RT in Norway and its impact on treatment outcomes.

PATIENTS AND METHODS:

Data from The Norwegian Colorectal Cancer Registry were used to identify all stage I-III rectal cancers treated with major resection (1997-2011: n=9193). Cumulative risk of local recurrence, distant metastasis, and relative survival was estimated for patients in 2007-2011 (n=3179). Multivariate regression-models were used to compare outcomes following preoperative (C)RT and surgery versus surgery alone.

RESULTS:

The proportion of patients given preoperative (C)RT increased from 5% to 49% during 1997-2011. Preoperative (C)RT was associated with reduced risk of local recurrence (hazard ratio (HR)=0.55; 95% CI=0.29-1.04) and a tendency of improved survival (excess HR=0.75; 95% CI=0.52-1.08) with significant effects in patients aged ≥70years (local recurrence: HR=0.35; 95% CI=0.13-0.91; survival: excess HR=0.58; 95% CI=0.35-0.95).

CONCLUSIONS:

This study indicates that when use of preoperative (C)RT is restricted to selected high-risk rectal cancers, preoperative (C)RT is associated with improved local recurrence, and possibly improved survival, when studied on a population-based level.

KEYWORDS:

Local recurrence; Population-based; Preoperative chemoradiotherapy; Rectal cancer; Survival

PMID:
28483302
DOI:
10.1016/j.radonc.2017.04.012
[Indexed for MEDLINE]

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