Abstract
Objective: Aim of this study is analysing the pooled results of Intra-Operative Electron beam Radiotherapy (IOERT) containing multimodality treatment of locally recurrent rectal cancer (LRRC) of two major treatment centres.
Methods and materials: Five hundred sixty five patients with LRRC who underwent multimodality-treatment up to 2010 were studied. The preferred treatment was preoperative chemo-radiotherapy, surgery and IOERT. In uni- and multivariate analyses risk factors for local re recurrence, distant metastasis free survival, relapse free survival, cancer-specific survival and overall survival were studied.
Results: Two hundred fifty one patients (44%) underwent a radical (R0) resection. In patients who had no preoperative treatment the R0 resection rate was 26%, and this was 43% and 50% for patients who respectively received preoperative re-(chemo)-irradiation or full-course radiotherapy (p <0.0001). After uni-and multivariate analysis it was found that all oncologic parameters were influenced by preoperative treatment and radicality of the resection. Patients who were re-irradiated had a similar outcome compared to patients, who were radiotherapy naive and could undergo full-course treatment, except the chance of local re-recurrence was higher for re-irradiated patients. Waiting-time between preoperative radiotherapy and IOERT was inversely correlated with the chance of local re-recurrence, and positively correlated with the chance of a R0 resection.
Conclusions: R0 resection is the most important factor influencing oncologic parameters in treatment of LRRC. Preoperative (chemo)radiotherapy increases the chance of achieving radical resections and improves oncologic outcomes. Short waiting-times between preoperative treatment and IOERT improves the effectiveness of IOERT to reduce the chance of a local re-recurrence. (C) 2016 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Original language | English |
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Pages (from-to) | 107-117 |
Number of pages | 11 |
Journal | European Journal of Surgical Oncology |
Volume | 43 |
Issue number | 1 |
DOIs | |
Publication status | Published - Jan 2017 |
Keywords
- Locally recurrent rectal cancer
- Multimodality treatment
- Chemo-radiation therapy
- Re-irradiation
- Local re-recurrence
- Intra Operative Electron beam Radiation Therapy
- INTRAOPERATIVE RADIATION-THERAPY
- COLORECTAL-CANCER
- PREOPERATIVE RADIOTHERAPY
- SURGICAL RESECTION
- IRRADIATION
- MANAGEMENT
- SURGERY
- CHEMORADIOTHERAPY
- CHEMORADIATION
- REIRRADIATION