Economics of Preoperative Radiotherapy With Total Mesorectal Excision: What Can We Learn From the Dutch Experience?

Patients undergoing rectal cancer surgery may also receive radiation therapy to reduce local tumor recurrence and improve survival [1,2]. In parts of Europe, a 5-day course of preoperative radiotherapy (PRT) alone is recommended for most patients, while other European and North American countries utilize a 5-week course of postoperative chemoradiotherapy for patients with stage II or III tumors [3]. Total mesorectal excision (TME) stresses sharp and complete dissection of the mesorectum, the lymph node– bearing portion of the rectum [4]. Compared with traditional blunt rectal cancer surgery, TME seems to lead to superior rates of sphincter preservation, local tumor control, and survival [4]. The Dutch Colorectal Cancer Group has conducted a randomized trial that compared outcomes of TME, with and without PRT, for patients with resectable rectal cancer [5]. At a median follow-up of 2 years, local recurrence rates were 2.4% and 8.2% for radiated and nonradiated patients, respectively, with no significant difference in overall survival [5]. These results may change with further follow-up. In this issue of the Journal of Clinical Oncology, van den