***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE The optimal timing of surgery after preoperative radiotherapy in rectal cancer is unknown . The aim of this trial was to evaluate the role of the interval between preoperative radiotherapy and surgery . PATIENTS AND METHODS Patients with rectal carcinoma accessible to rectal digital examination , staged T2 to T3 , NX , M0 , were r and omized before radiotherapy ( 39 Gy in 13 fractions ) into two groups : in the short interval ( SI ) group , surgery had to be performed within 2 weeks after completion of radiation therapy , compared with 6 to 8 weeks in the long interval ( LI ) group . Between 1991 and 1995 , 201 patients were enrolled onto the study . RESULTS A long interval between preoperative radiotherapy and surgery was associated with a significantly better clinical tumor response ( 53 . 1 % in the SI group v 71.7 % in the LI group , P = .007 ) and pathologic downstaging ( 10.3 % in the SI group v 26 % in the LI group , P = .005 ) . At a median follow-up of 33 months , there were no differences in morbidity , local relapse , and short-term survival between the two groups . Sphincter-preserving surgery was performed in 76 % of cases in the LI group versus 68 % in the SI group ( P = 0.27 ) . CONCLUSION A long interval between preoperative irradiation and surgery provides increased tumor downstaging with no detrimental effect on toxicity and early clinical results . When sphincter preservation is question able , a long interval may increase the chance of a successful sphincter-saving surgery The Stockholm III Trial r and omized patients with primary operable rectal cancers to either short‐course radiotherapy ( RT ) with immediate surgery ( SRT ) , short‐course RT with surgery delayed 4–8 weeks ( SRT‐delay ) or long‐course RT with surgery delayed 4–8 weeks . This preplanned interim analysis examined the pathological outcome of delaying surgery Objective : To compare acute adverse events ( AE ) and postoperative complication rates in a r and omized trial of short-course ( SC ) versus long-course ( LC ) preoperative radiotherapy . Background : Evidence demonstrates that adding neoadjuvant radiotherapy to surgery offers better local control in the management of rectal cancer . With both SC and LC therapy there is a potential for acute treatment-related toxicity and increased patient morbidity . Methods : Eligible patients had clinical -stage T3 rectal adenocarcinoma within 12 cm of the anal verge with no evidence of metastasis .  SC consisted of pelvic radiotherapy 5 × 5 Gy in 1 week , early surgery and 6 courses of adjuvant chemotherapy . LC was 50.4 Gy administered in 28 fractions during 5.5 weeks , with infusion 5-fluorouracil , surgery in 4 to 6 weeks , and 4 courses of chemotherapy . Results : All SC patients and 93 % of LC patients received preoperative planned radiotherapy . There was no 30-day operative mortality . A statistically significant higher percentage of at least 1 AE occurred in the LC group ( SC , 72.3 % ; LC , 99.4 % ; P < 0.001 ) . There were significant differences in favor of SC for grade 3 AE : radiation dermatitis ( 0 % vs 5.6 % , P = 0.003 ) , proctitis ( 0 % vs 3.7 % P = 0.016 ) , nausea ( 0 % vs 3.1 % , P = 0.029 ) , fatigue ( 0 % vs 3.7 % , P = 0.016 ) and grade 3/4 diarrhea rates ( 1.3 % vs 14.2 % P < 0.001 ) . No statistically significant differences in surgical complication rates were seen ( SC 53.2 vs 50.4 % LC , p = 0.68 ) , although permanent stoma ( 38.0 % vs 29.8 % , P = 0.13 ) and anastomotic breakdown ( 7.1 % vs 3.5 % , P = 0.26 ) rates favored LC  with perineal wound complications ( 38.3 % vs 50.0 % , P = 0.26 ) in favor of SC . Conclusions : LC had significantly higher AEs compared with SC with no statistically significant differences in postoperative complications . There were clinical trends in permanent stoma rates and anastomotic leaks in favor of LC but with an increased perineal wound breakdown rate Background There still is no evidence which neoadjuvant therapy regimen for stage II – III rectal cancer is superior . The aim of this study was to compare results achieved after long-course chemoradiotherapy ( CRT ) with short-term radiotherapy ( RT ) followed by delayed surgery . Methods A r and omized trial was carried out between 2007–2013 . One hundred fifty patients diagnosed with stage II – III rectal cancer were r and omized into one of two neoadjuvant treatment arms : conventional chemoradiotherapy ( CRT ) and short-term radiotherapy ( RT ) followed by surgery after 6–8 weeks . Primary endpoints of this trial were downstaging and pathological complete response rate . Secondary endpoints were local recurrence rate and overall survival . Results The pathological complete response was found in 3 ( 4.4 % ) cases after RT and 8 ( 11.1 % ) after CRT ( P = 0.112 ) . Downstaging ( stage 0 and I ) was observed in 21 ( 30.9 % ) cases in RT group vs. 27 ( 37.5 % ) cases in CRT group ( P = 0.409 ) . Median follow-up time was 39.7 ( range 4.9–79.7 ) months . 3-years overall survival ( OS ) was 78 % in RT group vs. 82.4 % in CRT group ( P = 0.145 ) , while disease-free survival ( DFS ) differed significantly – 59 % in RT group vs. 75.1 % in CRT group ( P = 0,022 ) . Hazard ratio of cancer progression for RT patients was 1.93 ( 95 % CI : 1.08–3.43 ) compared to CRT patients . Conclusion Three-years disease-free survival was better in CRT group comparing with RT group with no difference in overall survival . Trial registration http:// clinical trials.gov identifier NCT00597311 . January 2008 Background Current st and ard for most of the locally advanced rectal cancers is preoperative chemoradiotherapy , and , variably per institution , postoperative adjuvant chemotherapy . Short-course preoperative radiation with delayed surgery has been shown to induce tumour down-staging in both r and omized and observational studies . The concept of neo-adjuvant chemotherapy has been proven successful in gastric cancer , hepatic metastases from colorectal cancer and is currently tested in primary colon cancer . Methods and design Patients with rectal cancer with high risk features for local or systemic failure on magnetic resonance imaging are r and omized to either a st and ard arm or an experimental arm . The st and ard arm consists of chemoradiation ( 1.8 Gy x 25 or 2 Gy x 25 with capecitabine ) preoperatively , followed by selective postoperative adjuvant chemotherapy . Postoperative chemotherapy is optional and may be omitted by participating institutions . The experimental arm includes short-course radiotherapy ( 5 Gy x 5 ) followed by full-dose chemotherapy ( capecitabine and oxaliplatin ) in 6 cycles before surgery . In the experimental arm , no postoperative chemotherapy is prescribed . Surgery is performed according to TME principles in both study arms . The hypothesis is that short-course radiotherapy with neo-adjuvant chemotherapy increases disease-free and overall survival without compromising local control . Primary end-point is disease-free survival at 3 years . Secondary endpoints include overall survival , local control , toxicity profile , and treatment completion rate , rate of pathological complete response and microscopically radical resection , and quality of life . Discussion Following the advances in rectal cancer management , increased focus on survival rather than only on local control is now justified . In an experimental arm , short-course radiotherapy is combined with full-dose chemotherapy preoperatively , an alternative that offers advantages compared to concomitant chemoradiotherapy with or without postoperative chemotherapy . In a multi-centre setting this regimen is compared to current st and ard with the aim of improving survival for patients with locally advanced rectal cancer . Trial registration Clinical Trials.gov Introduction Multimodality therapy , including preoperative chemoradiotherapy ( CRT ) and total mesorectal excision ( TME ) , has effectively reduced local recurrence rates of rectal cancer over the past decade . However , the benefits and risks of the addition of neoadjuvant CRT to surgery need to be evaluated . This study was to compare the efficacy of TME with versus without preoperative concurrent chemoradiotherapy ( CCRT ) involving XELOX regimen ( oxaliplatin plus capecitabine ) in Chinese patients with stages II and III mid/low rectal adenocarcinoma . Methods We r and omly assigned patients to the TME group ( TME without preoperative CCRT ) or CCRT + TME group ( TME with preoperative CCRT ) .  The primary endpoint was disease-free survival ( DFS ) ; the secondary endpoints were overall survival ( OS ) , local and distant recurrence , tumor response to CRT , toxicity , sphincter preservation , and surgical complications . An interim analysis of the potential inferiority of DFS in the CCRT + TME group was planned when the first 180 patients had been followed up for at least 6 months . Results A total of 94 patients in the TME group and 90 patients in the CCRT + TME group were able to be evaluated . The 3-year DFS and OS rates were 86.3 % and 91.5 % in the whole cohort , respectively . The 3-year DFS rates of the TME and CCRT + TME groups were 85.7 % and 87.9 % ( P = 0.766 ) , respectively , and the 3-year OS rates were 90.7 % and 92.3 % ( P = 0.855 ) , respectively . The functional sphincter preservation rates of the TME and CCRT + TME groups were 71.3 % and 70.0 % ( P = 0.849 ) , respectively . In the TME group , 16 ( 17.0 % ) patients were proven to have pTNM stage I disease after surgery . In the CCRT + TME group , 32 ( 35.6 % ) patients achieved a pathologic complete response ( pCR ) . Conclusions Preliminary results indicated no significant differences in the DFS , OS , or functional sphincter preservation rates between the TME and CCRT + TME groups . However , preoperative CCRT with XELOX yielded a high pCR rate . Newer techniques are needed to improve the staging accuracy , and further investigation is warranted . Clinical trial registration numberChi PURPOSE To evaluate the long-term effects on survival and recurrence rates of preoperative radiotherapy in the treatment of curatively operated rectal cancer patients . PATIENTS AND METHODS Of 1,168 r and omly assigned patients in the Swedish Rectal Cancer Trial between 1987 and 1990 , 908 had curative surgery ; 454 of these patients had surgery alone , and 454 were administered  preoperative radiotherapy  ( 25 Gy in 5 days ) followed by surgery within 1 week . Follow-up was performed by matching against three Swedish nationwide registries ( the Swedish Cancer Register , the Hospital Discharge Register , and the Cause of Death Register ) . RESULTS Median follow-up time was 13 years ( range , 3 to 15 years ) . The overall survival rate in the irradiated group was 38 % v 30 % in the nonirradiated group ( P = .008 ) . The cancer-specific survival rate in the irradiated group was 72 % v 62 % in the nonirradiated group ( P = .03 ) , and the local recurrence rate was 9 % v 26 % ( P < .001 ) , respectively . The reduction of local recurrence rates was observed at all tumor heights , although it was not statistically significant for tumors greater than 10 cm from the anal verge . CONCLUSION Preoperative radiotherapy with 25 Gy in 1 week before curative surgery for rectal cancer is beneficial for overall and cancer-specific survival and local recurrence rates after long-term follow-up PURPOSE To assess health-related quality of life ( HRQOL ) in patients participating in a r and omised trial of neoadjuvant short course radiation ( SC ) or long course chemoradiation ( LC ) for operable rectal cancer . PATIENTS AND METHODS Eligible patients with T3N0 - 2M0 rectal cancer completed the European Organisation for Research and Treatment of Cancer quality of life question naire ( QLQ-C30 ) and the colorectal cancer specific module ( QLQ C38 ) at r and omisation and 1 , 2 , 3 , 6 , 9 and 12 months later . RESULTS Of 326 patients r and omised , 297 ( SC 143 , LC 154 ) were eligible for completion of HRQOL question naires . Baseline scores were comparable across the SC and LC groups . Patients reported low scores on sexual functioning and sexual enjoyment . Defaecation problems were the worst of the sympt 
    Output:
    
In terms of survival outcomes , adding either PLCRT or PSRT both showed obvious advantages for local control compared to surgery alone , and PSRT and PLCRT had similar long‐term outcomes irrespective of pairwise or network meta‐analyses .
Moreover , on the basis of health‐related quality ‐of‐life scores  , PSRT and PLCRT also had no overall differences .
Systematic review of current evidence indicates that the insufficiency of PSRT on pCR might be improved by delayed surgery or adding consolidation chemotherapy .
Conclusions PSRT could be the treatment of choice compared to PLCRT when pCR is not the primary aim .