"Not After Surgery, but Before"—The Treatment Sequence for Rectal Cancer Changes After 15 Years [Health Check]

[Financial News] Is it better for patients with rectal cancer to receive radiotherapy before or after surgery? Research shows that treatment has shifted clearly toward preoperative radiotherapy over the past 15 years.
A team led by Professor Jang Jeong-yoon of the Department of Radiation Oncology at Konkuk University Medical Center analyzed the medical records of 6,314 patients with nonmetastatic rectal cancer who received treatment with curative intent between 2008 and 2022. The patients were treated at Samsung Medical Center, while Jang, a researcher affiliated with Konkuk University Medical Center, served as the paper's first author. The findings were published in the international journal BMC Cancer (IF = 4.1).
The researchers divided the 15-year period into five three-year intervals—2008-2010, 2011-2013, 2014-2016, 2017-2019, and 2020-2022—and compared changes in treatment patterns and survival outcomes.
The proportion of patients who underwent surgery after receiving preoperative radiotherapy or chemoradiotherapy rose from 25.5% in 2008-2010 to 42.4% in 2020-2022. By contrast, among patients who received radiotherapy, the proportion who underwent postoperative adjuvant radiotherapy fell from 40.0% to 9.4% over the same period. The focus of treatment shifted from the postoperative period to the preoperative period.
Among patients who underwent surgery, the proportion receiving minimally invasive procedures, including laparoscopic and robotic surgery, also increased from 44.5% to 91.0%. The use of intensity-modulated radiotherapy—which delivers radiation precisely to tumors while reducing the dose reaching healthy tissue—and capecitabine-based chemotherapy, using an oral anticancer drug, also increased.
The five-year survival rate for all patients in the study was 87.6%. Survival outcomes steadily improved over time. The standardized mortality ratio (SMR), which indicates how much higher the risk of death is compared with that of the general population matched for age and sex, also declined over the 15-year period. An SMR above 1 indicates a higher risk of death than in the general population. The SMR fell from 5.57 in the earliest period, 2008-2010, to 3.33 in the most recent period, 2020-2022, indicating that the gap in mortality risk between the patients and the general population had narrowed.
Professor Jang said, "The significance of this study lies in examining changes in treatment strategies alongside survival outcomes through the long-term medical records of more than 6,000 patients." Jang added, "As we confirmed an improving trend in survival outcomes alongside actual changes in clinical practice, such as the expansion of preoperative treatment and minimally invasive surgery, it is necessary to continue developing multidisciplinary treatment strategies tailored to each patient's condition."
However, the research team explained that this was an observational study analyzing actual medical records, rather than a clinical trial directly demonstrating the effectiveness of a specific treatment. Because treatment choices can vary depending on a patient's disease stage and overall condition, the changes in treatment patterns and survival outcomes identified in this study should be viewed as a trend that emerged over the same 15-year period, rather than as a causal relationship, the team added.


[email protected] Jeong Myeong-jin, Medical Specialist Reporter