Intervention Review

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Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer

  1. Laura De Caluwé,
  2. Yves Van Nieuwenhove,
  3. Wim P Ceelen*

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 28 FEB 2013

Assessed as up-to-date: 16 JUL 2012

DOI: 10.1002/14651858.CD006041.pub3

How to Cite

De Caluwé L, Van Nieuwenhove Y, Ceelen WP. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD006041. DOI: 10.1002/14651858.CD006041.pub3.

Author Information

  1. Ghent University Hospital, Department of GI Surgery, Ghent, Belgium

*Wim P Ceelen, Department of GI Surgery, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 28 FEB 2013



References to studies included in this review

  1. References to studies included in this review
  2. References to ongoing studies
  3. Additional references
Bosset 2006 {published data only}
  • Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, et al.EORTC Radiotherapy Group Trial 22921. Chemotherapy with Preoperative Radiotherapy in Rectal Cancer. The New England Journal of Medicine 2006;355:1114-23.
Boulis-Wassif 1984 {published data only}
  • Boulis-Wassif S, Gerard A, Loygue J, Camelot D, Buyse M, Duez N. Final Results of a Randomized Trial on the Treatment of Rectal Cancer with Preoperative Radiotherapy Alone or in Combination With 5-Fluorouracil, Followed by radical surgery. Cancer 1984;53:1811-1818.
Bujko 2006 {published data only}
  • Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. British Journal of Surgery 2006;93:1215-1223.
Gerard 2006 {published data only}
  • Gérard J-P, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin M-T, et al. Preoperative Radiotherapy With or Without Concurrent Fluorouracil and Leucovorin in T3-T4 Rectal Cancers: Results of FFCD 9203. J Clin Oncol 2006;24:4620-4625.
Latkauskas 2011 {published and unpublished data}
  • Latkauskas T, Pauzas H, Gineikiene I, Janciauskiene R, Juozaityte E, Saladzinskas Z, et al. Initial results of a randomized controlled trial comparing clinical and pathological downstaging of rectal cancer after preoperative short-course radiotherapy or long-term chemoradiotherapy, both with delayed surgery. Colorectal Dis 2011;14(3):294-298.

References to ongoing studies

  1. References to studies included in this review
  2. References to ongoing studies
  3. Additional references
Siegel 2009 {published and unpublished data}
  • Siegel R, Burock S, Wernecke KD, Kretzschmar A, Dietel M, Loy V, et al. Preoperative short-course radiotherapy versus combined radiochemotherapy in locally advanced rectal cancer: a multi-centre prospectively randomised study of the Berlin Cancer Society. BMC Cancer 2009;9:50.

Additional references

  1. References to studies included in this review
  2. References to ongoing studies
  3. Additional references
Ammann 2003
  • Ammann K, Kirchmayr W, Klaus A, Muhlmann G, Kafka R, Oberwalder M, et al. Impact of neoadjuvant chemoradiation on anal sphincter function in patients with carcinoma of the midrectum and low rectum. Archives of Surgery 2003;138(3):257-261.
Beets-Tan 2003
  • Beets-Tan RGH, Beets GL. Rectal cancer: how accurate can imaging predict the T stage and the circumferential resection margin?. International Journal of Colorectal Disease 2003;18(5):385-391.
Beets-Tan 2005
  • Beets-Tan RGH, Lettinga T, Beets GL. Pre-operative imaging of rectal cancer and its impact on surgical performance and treatment outcome. Ejso 2005;31(6):681-688.
Bosset 2000
  • Bosset JF, Magnin V, Maingon P, Mantion G, Pelissier EP, Mercier M, et al. Preoperative radiochemotherapy in rectal cancer: Long-term results of a phase II trial. International Journal of Radiation Oncology Biology Physics 2000;46(2):323-327.
Bosset 2004
  • Bosset JF, Calais G, Daban A, Berger C, Radosevic-Jelic L, Maingon P, et al. Preoperative chemoradiotherapy versus preoperative radiotherapy in rectal cancer patients: assessment of acute toxicity and treatment compliance - Report of the 22921 randomised trial conducted by the EORTC Radiotherapy Group. European Journal of Cancer 2004;40(2):219-224.
Brown 2004
  • Brown G, Kirkham A, Williams GT, Bourne M, Radcliffe AG, Sayman J, et al. High-resolution MRI of the anatomy important in total mesorectal excision of the rectum. American Journal of Roentgenology 2004;182(2):431-439. [: 0361-803X]
Brown 2006
  • Brown G, Daniels IR, Heald RJ, Quirke P, Blomqvist L, Sebag-Montefiore D, et al. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. British Medical Journal 2006;333(7572):779-782. [: 0959-8146]
Bujko 2005
  • Bujko K, Nowacki MP, Kepka L, Oledzki J, Bebenek M, Kryj M, Polish Colorectal Study Group. Postoperative complications in patients irradiated pre-operatively for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs chemoradiation. Colorectal Disease 2005;7(4):410-416. [: 1462-8910]
Dahlberg 1998
  • Dahlberg M, Glimelius B, Graf W, Pahlman L. Preoperative irradiation affects functional results after surgery for rectal cancer - Results from a randomized study. Diseases of the Colon & Rectum 1998;41(5):543-549.
Dale 2005
  • Dale R, Carabe-Fernandez A. The radiobiology of conventional radiotherapy and its application to radionuclide therapy. CANCER BIOTHERAPY AND RADIOPHARMACEUTICALS     2005;20(1):47-51.
Daniels 2005
  • Daniels IR. High spatial resolution MRI predicts turnout spread in patients with rectal cancer - Results from the MERCURY study. Diseases of the Colon & Rectum 2005;48(3):688-689.
Enker 1999
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Feliu 2002
  • Feliu J, Calvillo J, Escribano A, de Castro J, Sanchez ME, Mata A, et al. Neoadjuvant therapy of rectal carcinoma with UFT-leucovorin plus radiotherapy. Annals of Oncology 2002;13(5):730-736.
Glimelius 2002
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Gray 2001
  • Gray R, Hills R, Stowe R, Clarke M, Peto R, Buyse M, et al. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials. Lancet 2001;358(9290):1291-1304.
Heald 1982
  • Heald RJ, Husband EM, Ryall RDH. The Mesorectum in Rectal-Cancer Surgery - the Clue to Pelvic Recurrence. British Journal of Surgery 1982;69(10):613-616. [: 0007-1323]
Heald 1998
  • Heald RJ, Moran BJ, Ryall RDH, Sexton R, MacFarlane JK. Rectal cancer - The Basingstoke experience of total mesorectal excision, 1978-1997. Archives of Surgery 1998;133(8):894-898.
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011].. The Cochrane Collaboration. Available from 2011.
Holm 1996
  • Holm T, Singnomklao T, Rutqvist LE, Cedermark B. Adjuvant preoperative radiotherapy in patients with rectal carcinoma - Adverse effects during long term follow-up of two randomized trials. Cancer 1996;78(5):968-976.
Kapiteijn 2001
  • Kapiteijn E, Marijnen CAM, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. New England Journal of Medicine 2001;345(9):638-646.
Mercier 2005
  • Mercier M, Pasquet P, Puyraveau M, Bosset J, Calais G, Mineur L, et al. Evaluation of the sphincter function and quality of life in French patients with rectal cancer who entered the EORTC 22921 study.. Eur J Cancer 2005;Supplements 3, No.2:171.
Minsky 1993
  • Minsky BD, Cohen AM, Kemeny N, Enker WE, Kelsen DP, Schwartz G, et al. Preoperative Combined 5-Fu, Low-Dose Leucovorin, and Sequential Radiation-Therapy for Unresectable Rectal-Cancer. International Journal of Radiation Oncology Biology Physics 1993;25(5):821-827.
Minsky 1997
  • Minsky BD, Cohen AM, Enker WE, Saltz L, Guillem JG, Paty PB, et al. Preoperative 5-FU, low-dose leucovorin, and radiation therapy for locally advanced and unresectable rectal cancer. International Journal of Radiation Oncology Biology Physics 1997;37(2):289-295.
Nagtegaal 2002
  • Nagtegaal ID, Marijnen CAA, Kranenbarg EK, van de Velde CJH, van Krieken J. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma - Not one millimeter but two millimeters is the limit. American Journal of Surgical Pathology 2002;26(3):350-357.
Osti 2004
  • Osti MF, Valeriani M, Masoni L, Tombolini V, Enrici RM. Neoadjuvant chemoradiation for locally advanced carcinoma of the rectum. Tumori 2004;90(3):303-309.
Peeters 2005
  • Peeters K, van de Velde CJH, Leer JWH, Martijn H, Junggeburt JMC, Kranenbarg EK, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: Increased bowel dysfunction in irradiated patients - A dutch colorectal cancer group study. Journal of Clinical Oncology 2005;23(25):6199-6206.
Peeters 2007
  • Peeters KC, Marijnen CA, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, et al. Dutch Colorectal Cancer Group. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 2007;246:693-701.
Quirke 1986
  • Quirke P, Dixon MF, Durdey P, Williams NS. Local Recurrence of Rectal Adenocarcinoma Due to Inadequate Surgical Resection - Histopathological Study of Lateral Tumor Spread and Surgical Excision. Lancet 1986;2(8514):996-999. [: 0140-6736]
Quirke 2003
  • Quirke P. Training and quality assurance for rectal cancer: 20 years of data is enough. Lancet Oncology 2003;4(11):695-702.
Rodel 2003
  • Rodel C, Grabenbauer GG, Papadopoulos T, Hohenberger W, Schmoll HJ, Sauer R. Phase I/II trial of capecitabine, oxaliplatin, and radiation for rectal cancer. Journal of Clinical Oncology 2003;21(16):3098-3104.
Sauer 2004
  • Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. New England Journal of Medicine 2004;351(17):1731-1740.
van den Brink 2004
  • van den Brink M, Stiggelbout AM, van den Hout WB, Kievit J, Kranenbarg EK, Marijnen CAM, et al. Clinical nature and prognosis of locally recurrent rectal cancer after total mesorectal excision with or without preoperative radiotherapy. Journal of Clinical Oncology 2004;22(19):3958-3964. [: 0732-183X]