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Impaired postoperative leucocyte counts after preoperative radiotherapy for rectal cancer in the Stockholm III Trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
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2013 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 100, no 7, 969-U145 p.Article in journal (Refereed) Published
Abstract [en]

Background: Radiotherapy (RT) in rectal cancer increases postoperative morbidity. A suggested reason is RT-induced bone marrow depression resulting in impaired leucocyte counts. The ongoing Stockholm III Trial randomizes patients with operable rectal cancers to short-course RT with immediate surgery (SRT), short-course RT with surgery delayed for 4-8 weeks (SRT-delay) and long-course RT with surgery delayed for 4-8 weeks (LRT-delay). This study examined differences between the randomization arms regarding leucocyte response and postoperative complications. Methods: Patients randomized in the Stockholm III Trial between October 1998 and November 2010 were included. Data were collected in a prospective register. Additional data were obtained by retrospective review of clinical records. Results: Of 657 randomized patients, 585 had data on leucocytes. The SRT arm had the highest proportion of postoperative complications (SRT, 52.5 per cent; SRT-delay, 39.4 per cent; LRT-delay, 41 per cent; P = 0.010). There was no association between low preoperative leucocyte count and postoperative complications (P = 0.238). Irrespective of randomization arm, patients with an impaired postoperative to preoperative leucocyte ratio had the highest rate of complications (low ratio, 56.6 per cent; intermediate ratio, 46.9 per cent; high ratio, 36.3 per cent; P = 0.010). The SRT arm had the highest proportion of low ratios (SRT, 48.9 per cent; SRT-delay, 22.8 per cent; LRT-delay, 22 per cent; P < 0.001). Conclusion: An impaired postoperative leucocyte response is associated with postoperative complications. The highest risk is with immediate surgery following short-course radiotherapy. Registration number: NCT 00904813 (http://www.clinicaltrials.gov). 

Place, publisher, year, edition, pages
2013. Vol. 100, no 7, 969-U145 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-201228DOI: 10.1002/bjs.9117ISI: 000318373000018OAI: oai:DiVA.org:uu-201228DiVA: diva2:626949

Presented in part to a meeting of the European Society of Coloproctology, Vienna, Austria, September 2012; published in abstract form as Colorectal Dis 2012;14(Suppl 2):8

Available from: 2013-06-10 Created: 2013-06-10 Last updated: 2013-06-10Bibliographically approved

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