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Abstract: Two countries − two treatment strategies for rectal cancer

M. Guren1, T.A. Myklebust2, K. Lundqvist3, A . Wibe4, B. Glimelius5

1Oslo University Hospital, Dept. of Oncology and K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway;
2Cancer Registry of Norway, Dept. of Registration, Oslo, Norway;
3Regional Cancer Center North, Umea, Sweden;
4St. Olavs Hospital, Dept. of Surgery, Trondheim, Norway;
5Uppsala University Hospital, Dept. of Immunology- Genetics and Pathology, Uppsala, Sweden

Background: Trials have shown that radiotherapy (RT) or chemoradiotherapy (CRT) decreases local recurrence rates, whereas the effects on survival are uncertain except in the most locally advanced cases. Sweden and Norway have had different treatment recommendations, and both countries have population-based rectal cancer registries. The purpose was to compare local recurrence rates and survival in the two countries.

Material and Methods: Between 1995 and 2012 all rectal cancer patients registered in the national quality registries in Sweden and Norway were included. Patient characteristics, stage, radiotherapy and surgery, recurrence, metastases, and survival were analyzed.

Results: In total, 29029 Swedish and 15456 Norwegian patients were analyzed. RT was given to 49% of patients in Sweden and 26% in Norway. In Sweden, no major changes in the proportion irradiated were observed, most patients received short-course RT, long-course (C)RT was given to 10−15%. In Norway, an increase in radiotherapy from about 10% in 1996 to 40% in 2012 was observed, most patients were given long-course (C)RT. Survival improved in both countries during the time period, and there was no difference in survival between countries. Patients with stage I-III disease who underwent major radical surgery (18541 in Sweden and 10421 in Norway) were further analyzed. Local recurrence rates were initially lower in Sweden (about 8%) than in Norway (about 12%) whereas they were equally low (4%) in both countries during the latter time period. About 20% of patients in both countries developed distant metastases within 5 years. The 5-year relative survival after curative resection increased in both countries from about 77% in 1996 to about 81% in 2009.

Conclusions: Two entirely different approaches to preoperative radiotherapy in rectal cancer, mostly preoperative short-course RT to every other patient in Sweden and selective preoperative CRT to initially very few followed by an increase towards 40% in Norway, resulted in similar survival. Local recurrence rates were initially lower in Sweden, but were in later years similar at a very low level of 4%. This opens for discussions regarding the optimal RT rate and technique. The quality of rectal cancer care is at a very high international level in both countries.

No conflict of interest

European Journal of Cancer Volume 72, Supplement 1, Page S49

© 2017 Elsevier Ltd. All rights reserved

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