Peeters KCMJ et al. (2007) The TME trial after a median follow-up of 6 years increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246: 693–701

Total mesorectal excision (TME) involving resection of the fatty tissue around the rectum is a successful treatment for colorectal cancer. Interim results of a large, prospective, randomized, multicenter trial, initiated by the Dutch Colorectal Cancer Group to investigate the efficacy of short term radiotherapy before TME, showed a reduced risk of local recurrence in irradiated patients 2 years after surgery.

Peeters et al. describe further results of this trial, in which 1,861 patients with resectable rectal cancer received TME preceded by radiotherapy or TME alone and were followed up for a median of 6.1 years. Radiotherapy significantly reduced the risk of local recurrence in patients who had nodal involvement, lesions 5–10 cm from the anal verge, or uninvolved circumferential resection margins. In total, 5.6% of the patients who received radiotherapy plus TME suffered a local recurrence, compared with 10.9% of patients who were treated by TME alone. At 5 years' follow-up, overall survival was 64.2% in those who received radiotherapy plus TME and 63.5% in those who received TME only.

The authors conclude that the beneficial effect of short-term radiotherapy before TME persists over time. They note, however, that the reduction in risk of local recurrence does not affect survival, which is mainly determined by distant metastases. They recommend that future treatment efforts should be directed towards preventing systemic disease.