Trial reportLancet (London, England)2009
Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial.
Trial report in Lancet (London, England), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 13 registered trials, which are not on this map. Cited by 551 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomised Trial Comparing Pre-Operative Radiotherapy and Selective Post-Operative Chemoradiotherapy in Rectal Cancer
the Effect of the Preoperative Short-course Radiotherapy for the cT3/cN+ Mid-lower Rectal Cancer: a Prospective Randomized Study
Preoperative Short-course Radiotherapy With Local Boost Versus Conventional Preoperative Short-course Radiotherapy for Rectal Cancer
Multicenter, Phase II Study of Preoperative Chemoradiotherapy With Raltitrexed for Intermediate or Locally Advanced Rectal Cancer in the Fit Elderly
Radical External Beam Chemoradiation in Patients With Rectal Cancer: a "Wait-and-see" Approach
Rectal Surgery Evaluation Trial (RESET): Laparotomy vs Laparoscopy vs Robotic vs TaTME Rectal Surgery Matched Parallel Cohort Trial for High Surgical Risk Cancer Patients, With Mid- to Low Rectal Cancer
DETECT: Defining the Target Volume for Endoluminal Radiation Boosting in Patients With Rectal Cancer
Chemotherapy Combined With High-dose Radiotherapy for Low Rectal Cancer Using Magnetic Resonance Guided Radiotherapy Linear Accelerator：A Prospective Phase 2 Trial
Organ Preservation in Rectal Adenocarcinoma Using Hypofractionated Pelvic Radiotherapy (Hypo-OPRA): A Phase II Clinical Trial
Impact of Neoadjuvant Chemoradiotherapy Versus Surgery Alone on Circulating Tumor Cells in Patients With Stage II-III Rectal Cancer and Negative Circumferential Resection Margin: a Multicenter Randomized Clinical Trial
Stereotactic Body Radiation Therapy for Unresectable Locally Recurrent Rectal Cancer: A Prospective, Single-arm, Phase II Study
The Efficacy of Combination of Modulated Electro-Hyperthermia(mEHT) in The Multimodality Management in Locally Advanced Rectal Cancer: A Multicenter Phase 3 Randomized Control Trial.
Short-Course Radiotherapy Followed by Liposomal Irinotecan, Capecitabine, and Camrelizumab as Neoadjuvant Therapy for Locally Advanced pMMR/MSS Low Rectal Cancer: A Prospective Single-Arm Phase II Trial Protocol
Who cites it
551 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Evaluating the Effectiveness of Proton Beam Therapy Compared to Conventional Radiotherapy in Non-Metastatic Rectal Cancer: A Systematic Review of Clinical Outcomes.Medicina (Kaunas, Lithuania) · 2024Pooled it
- Effectiveness of radiotherapy for local control in T3N0 rectal cancer managed with total mesorectal excision: a meta-analysis.Oncotarget · 2022Pooled it
- Two-Year Outcomes after Direct-to-Surgery in Good Prognosis Margin-Clear Stage II or III Rectal Cancer: The QuickSilver Study.Annals of surgical oncology · 2026Trial
- Neoadjuvant chemotherapy with FOLFOXIRI for high-risk relapsed locally advanced colon cancer: a single-arm phase II trial.ESMO open · 2025Trial
- The impact of anastomotic leak on long-term oncological outcomes after low anterior resection for mid-low rectal cancer: extended follow-up of a randomised controlled trial.International journal of colorectal disease · 2022Trial
- Radiotherapy regimens for rectal cancer: long-term outcomes and health-related quality of life in the Stockholm III trial.BJS open · 2021Trial
- Postoperative Chemoradiotherapy With Capecitabine and Oxaliplatin vs Capecitabine for Stage II to III Rectal Cancer: A Randomized Clinical Trial.JAMA network open · 2021Trial
- Reirradiation With Proton Therapy Using Hypofractionated Schedules: A Systematic Review of the Literature.International journal of particle therapy · 2026Review
- QResearch primary care records linked to national hospital and cancer registry data: a validation study.ESMO real world data and digital oncology · 2026Article
- Association of Pathological Complete Response with Long-Term Oncological Outcomes After Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer: A Retrospective Analysis of 327 Patients.Medicina (Kaunas, Lithuania) · 2026Article
- Local recurrence in rectal cancer: from detection to structured reporting.Abdominal radiology (New York) · 2026Article
- Undifferentiated pelvic sarcoma 5 years post-radiochemotherapy for rectal adenocarcinoma: A case report.Oncology letters · 2026Article
- Report from the 27th Annual Western Canadian Gastrointestinal Cancer Consensus Conference on Colorectal Cancer, Calgary, Alberta, 26-27 September 2025: Advances in Colon and Rectal Cancer.Current oncology (Toronto, Ont.) · 2026Article
- Application of deep learning on MRI for prognostic prediction in rectal cancer.European radiology · 2026Article
- The Diagnostic Value of Deep Learning for Multi-Classification of Rectal Cancer T Staging Based on Regional Attention.Diagnostics (Basel, Switzerland) · 2026Article
- The Role of MRI in Non-Operative Management of Locally Advanced Rectal Cancer.Journal of gastrointestinal cancer · 2026Review
- Response assessment in rectal cancer undergoing total neoadjuvant therapy: decision tree analysis integrating contrast enhanced T1-weighted MRI.Cancer imaging : the official publication of the International Cancer Imaging Society · 2026Article
- Managing Rectal Adenocarcinoma in a Radiation-Exposed Patient: A Case Report Utilizing the PROSPECT Trial Protocol.Cureus · 2026Article
- Prognostic value and predictive biomarkers of synergistic interaction between tumor-associated macrophages and cancer stem cells in colorectal cancer.Molecular and clinical oncology · 2026Article
- Interpretable AI-driven prediction of early postoperative recurrence in locally advanced rectal cancer using the Systemic Inflammatory-Nutritional Index (SINTI): A multi-center study and clinical web tool.International journal of colorectal disease · 2026Article
491 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
14 authors.
Funding
Abstract
backgroundPreoperative or postoperative radiotherapy reduces the risk of local recurrence in patients with operable rectal cancer. However, improvements in surgery and histopathological assessment mean that the role of radiotherapy needs to be reassessed. We compared short-course preoperative radiotherapy versus initial surgery with selective postoperative chemoradiotherapy.
methodsWe undertook a randomised trial in 80 centres in four countries. 1350 patients with operable adenocarcinoma of the rectum were randomly assigned, by a minimisation procedure, to short-course preoperative radiotherapy (25 Gy in five fractions; n=674) or to initial surgery with selective postoperative chemoradiotherapy (45 Gy in 25 fractions with concurrent 5-fluorouracil) restricted to patients with involvement of the circumferential resection margin (n=676). The primary outcome measure was local recurrence. Analysis was by intention to treat. This study is registered, number ISRCTN 28785842.
findingsAt the time of analysis, which included all participants, 330 patients had died (157 preoperative radiotherapy group vs 173 selective postoperative chemoradiotherapy), and median follow-up of surviving patients was 4 years. 99 patients had developed local recurrence (27 preoperative radiotherapy vs 72 selective postoperative chemoradiotherapy). We noted a reduction of 61% in the relative risk of local recurrence for patients receiving preoperative radiotherapy (hazard ratio [HR] 0.39, 95% CI 0.27-0.58, p<0.0001), and an absolute difference at 3 years of 6.2% (95% CI 5.3-7.1) (4.4% preoperative radiotherapy vs 10.6% selective postoperative chemoradiotherapy). We recorded a relative improvement in disease-free survival of 24% for patients receiving preoperative radiotherapy (HR 0.76, 95% CI 0.62-0.94, p=0.013), and an absolute difference at 3 years of 6.0% (95% CI 5.3-6.8) (77.5%vs 71.5%). Overall survival did not differ between the groups (HR 0.91, 95% CI 0.73-1.13, p=0.40).
interpretationTaken with results from other randomised trials, our findings provide convincing and consistent evidence that short-course preoperative radiotherapy is an effective treatment for patients with operable rectal cancer.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.