INITIAL REPORT FROM A SWEDISH MULTICENTER STUDY EXAMINING THE ROLE OFPREOPERATIVE IRRADIATION IN THE TREATMENT OF PATIENTS WITH RESECTABLERECTAL-CARCINOMA

Between March 1987 and February 1990, 1168 patients with resectable re ctal cancer were recruited into a nationwide Swedish trial. Patients w ere randomly allocated to receive either preoperative irradiation (25 Gy in five fractions over 1 week) followed by surgery within 1 week, o r surgery alone. In each group 454 patients underwent curative surgery . The groups were well matched for age, sex and surgical procedure. Th e postoperative mortality rates did not differ: 4 per cent after irrad iation versus 3 per cent after surgery alone, but the postoperative mo rtality 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 receivi ng irradiation (20 versus 10 per cent, P < 0.001). No difference in th e incidence of anastomotic dehiscence or other postoperative complicat ion was found between the groups. Preoperative radiotherapy with a sho rt-term high-dose technique can be delivered without major acute adver se effects, provided the irradiation technique is optimized.