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This study compared long-term population-based survival outcomes of preoperative and postoperative radiotherapy (RT) approaches in rectal cancer. Patients with stage II-III rectal cancer between 1998 and 2013 were identified using the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and disease-specific survival (DSS) rates were estimated in propensity-matched study population according to the use of RT. Among the 28,320 eligible patients, a total of 18,400 patients were identified from propensity score matching process balancing the distribution of prognostic covariates. The 10-year OS and DSS rates were higher in patients with preoperative RT than the postoperative group (51.6% vs. 49.8% with  P  < 0.001, and 65.4% vs. 64.8% with  P  = 0.037, respectively). However, in multivariate analysis, selection of combined RT sequence did not affect the survival (hazard ratio [HR] 1.04 and 95% confidence interval [CI] 0.98−1.10 for OS; HR 0.97 and 95% CI 0.90−1.05 for DSS). Regarding hazard rate functions of cancer-specific mortality, the overall time-course risks after preoperative and postoperative RT were comparable. This study provides additional insight into the long-term prognostic implications of the two RT strategies, suggesting that the sequence of RT does not lead to differential survival in stage II-III rectal cancer.

Comparative survival analysis of preoperative and postoperative radiotherapy in stage II-III rectal cancer on the basis of long-term population data