LISBON, PortugalShort-term preoperative radiotherapy significantly
lowers the risk of local recurrence in patients with rectal cancer who undergo
standardized total mesorectal excision (TME), Cornelis J.H. van de Velde, MD,
PhD, reported at the 11th European Cancer Conference (ECCO abstract 143). Dr.
van de Velde, a University of Leiden surgeon, chairs the Dutch Colorectal
Standardization and quality control were important foundations of the TME
study. Dr. van de Velde reminded the audience that the 1997 Swedish Rectal
Cancer Study, the first trial to establish the survival benefit of preoperative
radiotherapy, documented a 27% local recurrence rate among patients treated
with surgery alone.
In contrast, he emphasized, recurrence rates of only 10% have been reported
following standardized, good anatomical surgery in which the circumferential
margins are removed. So, the key question addressed by the TME trial was
whether preoperative radiotherapy can enhance local control even after optimal
To achieve standardization in the TME study, participating surgeons were
required to perform five operations under the supervision of an
"instructor surgeon" from another hospital before they were allowed
to enter patients into the trial. Surgery quality-control priorities included
nerve preservation, pouch anastomosis, and the avoidance of stomas by
performing low anterior resections. Pathology standards were also instituted.
The study investigators randomly assigned 1,861 patients with resectable
rectal cancer to receive radiotherapy, 5 Gy per day for 5 days, followed by TME
a week later, or to undergo TME without radiation therapy.
Combining preoperative radiotherapy with TME reduced the 2-year local
recurrence rate to 2.4%, compared with 8.2% among patients who underwent
surgery alone (P < .001). No difference in overall survival has yet become
apparent, Dr. van de Velde said.