ORIGINAL ARTICLE Preoperative radiation therapy for locally advanced rectal cancer: a comparison between two different time intervals to surgery A. A. F. A. Veenhof & R. H. J. Kropman & A. F. Engel & M. E. Craanen & S. Meijer & O. W. M. Meijer & D. L. van der Peet & M. A. Cuesta Accepted: 17 July 2006 / Published online: 29 September 2006 # Springer-Verlag 2006 Abstract Background Although it is now considered a standard treatment to irradiate an advanced mid or low rectal tumor before surgical total mesorectal excision (TME), the optimal time interval between radiation therapy and surgery remains controversial. Materials and methods Between 1995 and 2005, patients undergoing preoperative radiation therapy and TME for locally advanced mid and low rectal tumors treated in the VU Medical Center or the Zaans Medical Center were entered into this study. All patients received identical radiation treatment in the VU Medical Center and were subsequently operated on within 2 weeks in the Zaans Medical Center (SI group) and after 6–8 weeks in the VU Medical Center (LI group). Preoperative tumor staging, operative data, postoperative complications, pathology results, and follow-up were compared. Results The SI group (N=57) underwent surgery after a median delay of 4 days and the LI group (N=51) after 45 days. Operative data and short-term morbidity were comparable for both groups. However, significantly higher numbers of complete remissions (12 vs 0%), tumor down- staging (55 vs 26%), and less lymph-node metastases (22 vs 44%) were found in the LI group. No significant differences were found regarding local control or long-term survival after a median follow-up of 34 months. Conclusion Several advantages, such as complete remis- sions and downstaging in the LI group, do not appear to have expression in a better survival or less local recurrences after a median follow-up of 34 months. Although larger (randomized) studies will be needed for definite conclu- sions, this may indicate that patients can be operated on within 2 weeks after radiation therapy. Keywords Radiation therapy . Interval . Rectal cancer . Total mesorectal excision . Cancer Introduction Since the introduction of the total mesorectal excision (TME) concept by Heald et al. [1] in 1982, this procedure has now become the gold standard in surgical treatment of rectal cancer [2, 3]. To further reduce the local recurrence rate and to increase long-term survival after TME, different schemes of pre- and postoperative radiation therapy have been used for several years in the treatment of rectal cancer [4–10]. Previously, the Swedish Rectal Cancer Trial reported an improved 5-year survival rate for patients who received preoperative radiation therapy [6]. Moreover, in addition to the beneficial overall and cancer-specific survival rates, a Int J Colorectal Dis (2007) 22:507–513 DOI 10.1007/s00384-006-0195-5 A. A. F. A. Veenhof : R. H. J. Kropman : S. Meijer : D. L. van der Peet : M. A. Cuesta (*) Department of Surgery, VU Medical Center, de Boelelaan 1117, Postbus 7057, 1007 MB Amsterdam, The Netherlands e-mail: ma.cuesta@vumc.nl A. F. Engel Department of Surgery, Zaans Medical Center, Koningin Julianaplein 58, Zaandam, The Netherlands M. E. Craanen Department of Gastroenterology, VU Medical Center, de Boelelaan 1117, Amsterdam, The Netherlands O. W. M. Meijer Department of Radiation Oncology, VU Medical Center, de Boelelaan 1117, Amsterdam, The Netherlands