Results of a pooled analysis of IOERT containing multimodality treatment for locally recurrent rectal cancer: Results of 565 patients of two major treatment centres

F. A. Holman; S. J. Bosman; M. G. Haddock; L. L. Gunderson; M. Kusters; G. A. P. Nieuwenhuijzen; H. van den Berg; H. Nelson; H. J. Rutten

doi:10.1016/j.ejso.2016.08.015

Results of a pooled analysis of IOERT containing multimodality treatment for locally recurrent rectal cancer: Results of 565 patients of two major treatment centres

F. A. Holman
, S. J. Bosman
, M. G. Haddock
, L. L. Gunderson
, M. Kusters
, G. A. P. Nieuwenhuijzen
, H. van den Berg
, H. Nelson
, H. J. Rutten^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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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
Pages (from-to)	107-117
Number of pages	11
Journal	European Journal of Surgical Oncology
Volume	43
Issue number	1
DOIs	https://doi.org/10.1016/j.ejso.2016.08.015
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

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10.1016/j.ejso.2016.08.015

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Holman, F. A., Bosman, S. J., Haddock, M. G., Gunderson, L. L., Kusters, M., Nieuwenhuijzen, G. A. P., van den Berg, H., Nelson, H., & Rutten, H. J. (2017). Results of a pooled analysis of IOERT containing multimodality treatment for locally recurrent rectal cancer: Results of 565 patients of two major treatment centres. European Journal of Surgical Oncology, 43(1), 107-117. https://doi.org/10.1016/j.ejso.2016.08.015

@article{6e7637187ad74a5eb24fda5123e7c663,

title = "Results of a pooled analysis of IOERT containing multimodality treatment for locally recurrent rectal cancer: Results of 565 patients of two major treatment centres",

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.",

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",

author = "Holman, \{F. A.\} and Bosman, \{S. J.\} and Haddock, \{M. G.\} and Gunderson, \{L. L.\} and M. Kusters and Nieuwenhuijzen, \{G. A. P.\} and \{van den Berg\}, H. and H. Nelson and Rutten, \{H. J.\}",

year = "2017",

month = jan,

doi = "10.1016/j.ejso.2016.08.015",

language = "English",

volume = "43",

pages = "107--117",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "W.B. Saunders Ltd",

number = "1",

}

Holman, FA, Bosman, SJ, Haddock, MG, Gunderson, LL, Kusters, M, Nieuwenhuijzen, GAP, van den Berg, H, Nelson, H & Rutten, HJ 2017, 'Results of a pooled analysis of IOERT containing multimodality treatment for locally recurrent rectal cancer: Results of 565 patients of two major treatment centres', European Journal of Surgical Oncology, vol. 43, no. 1, pp. 107-117. https://doi.org/10.1016/j.ejso.2016.08.015

Results of a pooled analysis of IOERT containing multimodality treatment for locally recurrent rectal cancer: Results of 565 patients of two major treatment centres. / Holman, F. A.; Bosman, S. J.; Haddock, M. G. et al.
In: European Journal of Surgical Oncology, Vol. 43, No. 1, 01.2017, p. 107-117.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Results of a pooled analysis of IOERT containing multimodality treatment for locally recurrent rectal cancer

T2 - Results of 565 patients of two major treatment centres

AU - Holman, F. A.

AU - Bosman, S. J.

AU - Haddock, M. G.

AU - Gunderson, L. L.

AU - Kusters, M.

AU - Nieuwenhuijzen, G. A. P.

AU - van den Berg, H.

AU - Nelson, H.

AU - Rutten, H. J.

PY - 2017/1

Y1 - 2017/1

N2 - 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.

AB - 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.

KW - Locally recurrent rectal cancer

KW - Multimodality treatment

KW - Chemo-radiation therapy

KW - Re-irradiation

KW - Local re-recurrence

KW - Intra Operative Electron beam Radiation Therapy

KW - INTRAOPERATIVE RADIATION-THERAPY

KW - COLORECTAL-CANCER

KW - PREOPERATIVE RADIOTHERAPY

KW - SURGICAL RESECTION

KW - IRRADIATION

KW - MANAGEMENT

KW - SURGERY

KW - CHEMORADIOTHERAPY

KW - CHEMORADIATION

KW - REIRRADIATION

U2 - 10.1016/j.ejso.2016.08.015

DO - 10.1016/j.ejso.2016.08.015

M3 - Article

C2 - 27659000

SN - 0748-7983

VL - 43

SP - 107

EP - 117

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 1

ER -

Results of a pooled analysis of IOERT containing multimodality treatment for locally recurrent rectal cancer: Results of 565 patients of two major treatment centres

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