Rectal cancer treatment strategyTwo countries – Two treatment strategies for rectal cancer
Section snippets
Patients
The Norwegian Rectal Cancer Registry was established in 1993, and the Swedish Rectal Cancer Registry in 1995. Between 1995 and 2012 totally 29,029 patients in Sweden and 15,456 patients in Norway were registered (Table 1). These numbers correspond to an annual incidence of 18.8 per 100,000 inhabitants in Sweden and 19.5 in Norway. The corresponding age-standardized rates (World 1960) are 8.8 and 10.6, respectively.
Surgery, staging and adjuvant chemotherapy
The majority of surgeons had adopted the TME-technique in both countries prior to
Characteristics of patients with rectal cancer in Sweden and Norway
There were no differences in gender or age distribution between the countries (Table 1). Approximately 20% of the patients had synchronous metastases with a slightly higher proportion in Norway than Sweden, probably due to different registration routines. This proportion did not change with time (data not shown). A major resection (AR, HA, APE or rarely procto-colectomy) was performed in 66–69% of the patients and a local excision in 3–5% with no differences between countries. Patients who did
Discussion
The countries used two different approaches to rectal cancer treatment, preoperative radiotherapy plus TME to many patients in Sweden, and TME alone to most patients initially followed by an increased use of preoperative CRT during recent years in Norway. With these two different approaches, no survival differences could be detected. However, the local recurrence rates were initially lower in Sweden, until the use of CRT increased in Norway. In recent years, although RT regimens and rates
Conclusion
Over a time period of 19 years, population-based rectal cancer registry data from Sweden and Norway have shown that different treatment strategies have had an impact on local recurrence rates, but not on survival. At present, there are still differences in the use and choice of regimens of preoperative therapy, but both countries have similar good outcomes in terms of local recurrence and survival.
Conflict of interest
None of the authors have any conflict of interest to report.
Acknowledgements
Late Professor Lars Påhlman for his dedicated work to improve treatment and prognosis for rectal cancer patients worldwide and for his contribution to this work initially. Financial support was received from the Swedish Cancer Society, Sweden.
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2020, Radiotherapy and OncologyCitation Excerpt :The compliance for oxaliplatin-containing chemotherapy before surgery was 84% for patients in the experimental arm, compared to only 58% postoperatively in the standard arm. The occurrence of distant metastases is now the most common cause of uncontrollable disease in rectal cancer [17]. While it is established that adjuvant chemotherapy after curative resection improves disease-free and overall survival in patients with high-risk colon cancer, several trials and meta-analyses have failed to show a similar effect in rectal cancer patients who have already undergone neoadjuvant (chemo-)radiotherapy and curative surgery [3,18].
Should we favour the use of 5 × 5 preoperative radiation in rectal cancer
2019, Cancer Treatment ReviewsCitation Excerpt :In multivariable analysis, histological subtype, clinical stage and distance to anus were identified as independent predictors for tumour response (see Table 4). Population data mirror these findings when outcomes from each approach in Norway and Sweden were contrasted [19]. A smaller phase III trial with a similar design randomized 154 patients to SCPRT with surgery 7–10 days after the last fraction or to SCPRT with surgery 4–5 weeks later [30].