Palliative management of patients with locally recurrent rectal cancer: Clinical presentation, treatment strategies, and overall survival

Introduction: Locally recurrent rectal cancer (LRRC) occurs in 6-12 % of the patients after curative treatment for primary rectal cancer. Palliative treatment plays a critical role, as over half of the patients are ineligible for curative treatment. However, data on patients treated with palliative intent is limited. This study aims to evaluate palliative treatment strategies and overall survival (OS) in LRRC patients. Methods: We retrospectively included all LRRC discussed at the multidisciplinary team in a tertiary referral center, between May 2018 and June 2023. Patients treated with palliative intent were categorized as palliative due to locally unresectable disease, metastatic disease, frailty, or patient preference. Outcomes were OS, treatment response, duration of treatment effect, and hospital admissions. Local control was defined as response or stable disease on imaging. Results: Out of 188 patients, 58 (30.9 %) were treated with palliative intent. Palliative treatments included systemic therapy, chemoradiotherapy and radiotherapy. The median OS for patients treated with palliative intent was 22 months. 3-year OS was 27.1 %, compared to 73.1 % for curative intent patients. Patients with locally unresectable disease had a significantly better OS compared to patients with distant metastases (31 versus 12 months). Local control was achieved in 53.3 % of patients after any palliative treatment, with a median effect duration of 9 months. Chemoradiotherapy was associated with best results for local control. Conclusion: LRRC patients treated with palliative intent can experience substantial survival, particularly those with unresectable disease. Local control due to palliative treatment is feasible, possibly improving survival. Individualized palliative treatment is crucial.