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

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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",

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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 -