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- Title
Outcomes and prognostic factors of multimodality treatment for locally recurrent rectal cancer with curative intent.
- Authors
Bird, Thomas G.; Ngan, Samuel Y.; Chu, Julie; Kroon, René; Lynch, Andrew C.; Heriot, Alexander G.
- Abstract
Purpose: Radical management of locally recurrent rectal cancer (LRRC) can lead to prolonged survival. This study aims to assess outcomes and identify prognostic factors for patients with LRRC treated using a multimodality treatment protocol.Methods: An analysis of a prospectively maintained institutional database of consecutive patients who underwent radical surgical resection for LRRC was performed. Potential prognostic factors were investigated using a Cox proportional hazards model.Results: Ninety-eight patients were included in this study. A multimodality approach was taken in the majority, including preoperative chemoradiation (78%), intraoperative radiation therapy (47%) and adjuvant chemotherapy (41%). Extended resection was performed where required: bone resection (34%) and lateral pelvic sidewall dissection (31%). The rate of R0 resection was 66%. Estimated rates of 5-year overall survival (OS) and progression-free survival (PFS) were 41.8% (95% CI 32.5-53.7) and 22.5% (95% CI 15.3-33.1). On multivariate analysis, stage III disease at initial primary surgery, a positive margin at initial primary surgery, synchronous or previously resected oligometastases, a lateral or sacral invasive-type pelvic recurrence and the requirement for IORT all predicted for inferior PFS (<italic>p</italic> < 0.05). Eleven percent of patients subsequently underwent further pelvic surgery for pelvic re-recurrence and had an estimated 5-year OS rate of 54.5% (95% CI 29.0-100.0) from repeat surgery.Conclusions: Radical multimodality management of LRRC leads to prolonged survival in approximately 40% of patients. Those with sacral or lateral invasive-type recurrence or oligometastatic disease have inferior outcomes and further research is needed to optimise treatment for these groups.
- Subjects
SURGICAL excision; CANCER chemotherapy; RECTAL cancer; CHEMORADIOTHERAPY; METASTASIS
- Publication
International Journal of Colorectal Disease, 2018, Vol 33, Issue 4, p393
- ISSN
0179-1958
- Publication type
Article
- DOI
10.1007/s00384-018-2985-y