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Introduction: Short course preoperative radiotherapy (SCPRT) reduces local recurrence following total mesorectal excision (TME). In the Dutch TME trial the absolute reduction was 5.8% at 2 years (2.4% vs. 8.2%). This benefit should be weighed against acute and late side effects following combined treatment. We have previously reported acute toxicity in a series of 176 consecutive patients. The purpose of this study was to report late side effects in the same cohort of patients. Method: The hospital notes of 176 patients who underwent TME preceded by SCPRT were examined. Side effects occurring more than 3 months after the start of SCPRT were graded using the EORTC/RTOG late radiation toxicity system. A multivariate analysis was performed to identify associated factors. Results: Of 176 patients, 15 died within 3 months of SCPRT and 3 patients were lost to follow up. At a median follow up of 40 months severe (grade 3-4) toxicity was seen in 20 (13%) of 158 assessable patients (gastrointestinal 13 (8%); urological 3 (2%); thromboembolic 3 (2%); musculoskeletal 1 (1%)). On multivariate analysis, abdominoperineal (AP) resection (p < 0.001) and Dukes A tumours (p = 0.05) were associated with less severe toxicity. Conclusions: In this retrospective series the rate of late grade 3-4 toxicity following SCPRT and TME was 13%. Although AP resection is associated with a lower incidence of late physical side effects this may be counterbalanced by the impact of a stoma on quality of life. These factors should be considered when deciding on the most appropriate management for operable rectal cancers. [ABSTRACT FROM AUTHOR]

Replies to comments on the authors' study concerning toxicity following multimodality treatment. Difficulty associated with determining which modality is responsible for toxicity; Postoperative complications associated with multimodality treatment.