Abstract
PURPOSE: This study was designed to determine predictors of survival after surgery and intraoperative radiotherapy for recurrent rectal cancer. METHODS: From a prospective database, 634 patients undergoing resection for recurrent rectal cancer between January 1990 and June 2000 were identified. Of these, 111 received intraoperative radiotherapy with curative intent, and 100 were available for follow-up. Clinicopathologic variables from both the primary and recurrent operations were evaluated as predictors of disease-free and disease-specific survival by multivariate Cox regression and log-rank test. RESULTS: There were 54 males and 46 females, with a median age of 57 (range, 37–83) years. With a median follow-up of 23.2 months, 60 patients (60 percent) recurred: 20 (33 percent) locally, 27 (45 percent) distantly, and 13 (22 percent) at both sites. Of all variables analyzed, only complete resection with microscopically negative margins and the absence of vascular invasion in the recurrent specimen predicted improved disease-free and disease-specific survival (P < 0.01 for all). Median disease-free survival and median disease-specific survival were 31.2 and 66.1 months, respectively, for complete resection compared with 7.9 and 22.8 months for resection with microscopic or grossly positive margins (P < 0.01 for both). Median disease-free survival and median disease-specific survival were 6.4 and 16.1 months, respectively, in the presence of vascular invasion in the recurrent specimen compared with 23.3 and 57.3 months in the absence of vascular invasion (P < 0.01 and P < 0.05, respectively). Complete resection and the absence of vascular invasion were the only predictors of improved local control as well (P < 0.05 and P < 0.01, respectively). CONCLUSION: Resection with negative microscopic margins and absence of vascular invasion are independent predictors of local control and improved survival after resection and intraoperative radiotherapy for recurrent rectal cancer.
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References
FT McDermott ES Hughes E Pihl WR Johnson AB Price (1985) ArticleTitleLocal recurrence after potentially curative resection for rectal cancer in a series of 1008 patients Br J Surg 72 34–37
SJ Pilipshen M Heilweil SH Quan SS Sternberg WE Enker (1984) ArticleTitlePatterns of pelvic recurrence following definitive resections of rectal cancer Cancer 53 1354–1362
. Gastrointestinal Tumor Surgery Group (1985) ArticleTitleProlongation of the disease-free interval in surgically treated rectal carcinoma N Engl J Med 312 1465–1472
T Rich LL Gunderson R Lew JJ Galdibini AM Cohen G Donaldson (1983) ArticleTitlePatterns of recurrence of rectal cancer after potentially curative surgery Cancer 52 1317–1329
F Bozzetti L Bertario C Rosetti et al. (1997) ArticleTitleSurgical treatment of locally recurrent rectal carcinoma Dis Colon Rectum 40 1421–1424
JG Guillem L Ruo (1998) ArticleTitleStrategies in operative therapy for locally recurrent rectal cancer Semin Colon Rectal Surg 9 259–268
JP Welch GA Donaldson (1978) ArticleTitleDetection and treatment of recurrent cancer of the colon and rectum Am J Surg 135 505–508
CS Wong BJ Cummings JD Brierley et al. (1998) ArticleTitleTreatment of locally recurrent rectal carcinoma—results and prognostic factors Int J Radiat Oncol Biol Phys 40 427–435
R Schiessel M Wunderlich F Herbst (1986) ArticleTitleLocal recurrence of colorectal cancer Br J Surg 73 342–344
CJ Rominger DG Gelber LL Gunderson N Conner (1985) ArticleTitleRadiation therapy alone or in combination with chemotherapy in the treatment of residual or inoperable carcinoma of the rectum and rectosigmoid or pelvic recurrence following colorectal surgery Am J Clin Oncol 8 118–127
LB Harrison BD Minsky WE Enker et al. (1998) ArticleTitleHigh dose rate intraoperative radiation therapy (HDR-IORT) as part of the management strategy for locally advanced primary and recurrent rectal cancer Int J Radiat Oncol Biol Phys 42 325–330
KM Alektiar MJ Zelefsky PB Paty et al. (2000) ArticleTitleHigh-dose-rate intraoperative brachytherapy for recurrent colorectal cancer Int J Radiat Oncol Biol Phys 48 219–226
LL Gunderson JK Martin RW Beart et al. (1988) ArticleTitleIntraoperative and external beam irradiation for locally advanced colorectal cancer Ann Surg 207 52–60
O Abuchaibe FA Calvo I Azinovic J Aristu F Pardo J Alvarez-Cienfuegos (1993) ArticleTitleIntraoperative radiotherapy in locally advanced recurrent colorectal cancer Int J Radiat Oncol Biol Phys 26 859–867
LL Gunderson H Nelson JA Martenson (1996) ArticleTitleIntraoperative electron and external beam irradiation with or without 5-fluorouracil and maximum surgical resection for previously unirradiated, locally recurrent colorectal cancer Dis Colon Rectum 39 1379–1395
HJ Wallace CG Willett PC Shellito JJ Coen HC Hoover (1995) ArticleTitleIntraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer J Clin Oncol 60 122–127
HJ Wanebo J Koness MP Vezeridis SI Cohen DE Wrobleski (1994) ArticleTitlePelvic resection of recurrent rectal cancer Ann Surg 220 586–597
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Shoup, M., Guillem, J.G., Alektiar, K.M. et al. Predictors of Survival in Recurrent Rectal Cancer After Resection and Intraoperative Radiotherapy. Dis Colon Rectum 45, 585–592 (2002). https://doi.org/10.1007/s10350-004-6250-9
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DOI: https://doi.org/10.1007/s10350-004-6250-9