Neoadjuvant vs adjuvant pelvic radiotherapy for locally advanced rectal cancer: Which is superior?

Table 1 Randomized control trials evaluating timing and dose of radiation therapy

Trial (year results published)	Study design	Patients	Follow-up (mo)	Treatment	Outcome: overall survival	Outcome: local recurrence
Swedish Rectal Cancer Trial (1997)[10]	RCT	1168	60	Neoadjuvant short-course RT vs surgery alone	58% vs 48% (P = 0.004)	11% vs 27% (P < 0.001)
Dutch TME Trial (2001)[11]	RCT	1861	24	Neoadjuvant short-course RT (standard TME ) vs surgery alone	82% vs 81.8% (P = 0.84)	2.4% vs 8.2% (P < 0.001)
German Rectal Cancer Study Group (2004)[14]	RCT	799	60	Neoadjuvant long-course RT + chemotherapy vs adjuvant long-course RT + chemotherapy	76% vs 74% (P = 0.80)	6% vs 13% (P = 0.006)
Polish Colorectal Group (2006)[16]	RCT	312	48	Neoadjuvant short-course RT vs neoadjuvant long-course RT	67.2% vs 66.2% (P = 0.96)	14.2% vs 9% (P = 0.17)
MRC-NCIC (2009)[17]	RCT	1350	60	Neoadjuvant short-course RT vs selective adjuvant long-course RT + chemotherapy	70% vs 67.9% (HR 0.91, 95% CI: 0.73 to -1.13, P = 0.40)	4% vs 11% (HR 0.39, 95% CI: 0.27 to 0.58, P < 0.0001)
NSABP R-03 (2009)[18]	RCT	267	60	Neoadjuvant long-course RT + chemotherapy vs postoperative long-course RT + chemotherapy	74.5% vs 65.6% (P = 0.065)	10.7% vs 10.7% (P = 0.69)
Stockholm III (2010)1	RCT	303	Ongoing	Neoadjuvant short-course RT + surgery within 1 wk vs neoadjuvant short-course RT + surgery 4 to 8 wk later vs neoadjuvant long-course RT + surgery 4 to 8 wk later		Ongoing

¹Interim results. RCT: Randomized control trial; RT: Radiotherapy; TME: Total mesorectal excision; MRC-NICI: Medical Rectal Council-National Cancer Institute of Canada; NSABP: National Surgical Adjuvant Breast and Bowel Project; HR: Hazard ratio.