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10.1245/s10434-008-9896-z
Annals of Surgical Oncology 15:1937-1947 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Radical Resection After IORT-Containing Multimodality Treatment is the Most Important Determinant for Outcome in Patients Treated for Locally Recurrent Rectal Cancer

Raphaëla C. Dresen, MD1, Marleen J. Gosens, MSc1, Hendrik Martijn, MD, PhD2, Grard A. Nieuwenhuijzen, MD, PhD1, Geert-Jan Creemers, MD, PhD3, Alette W. Daniels-Gooszen, MD, PhD4, Adriaan J. van den Brule, MSc, PhD5, Hetty A. van den Berg, MD2 and Harm J. Rutten, MD, PhD1

1 Department of Surgery, Catharina Hospital Eindhoven, Postbox 1350, 5602 ZA Eindhoven, The Netherlands
2 Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
3 Department of Oncology, Catharina Hospital, Eindhoven, The Netherlands
4 Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
5 Laboratory for Pathology, PAMM Laboratories, Eindhoven, The Netherlands

Correspondence: Address correspondence and reprint requests to: Harm J. Rutten, MD, PhD; E-mail: harm.rutten{at}cze.nl

Background: The optimal treatment for locally recurrent rectal cancer (LRRC) is still a matter of debate. This study assessed the outcome of LRRC patients treated with multimodality treatment, consisting of neoadjuvant radio (chemo-) therapy, extended resection, and intraoperative radiotherapy.

Methods: One hundred and forty-seven consecutive patients with LRRC who underwent treatment between 1994 and 2006 were studied. The prognostic values of patient-, tumor- and treatment-related characteristics were tested with uni- and multivariate analysis.

Results: Median overall survival was 28 months (range 0–146 months). Five-year overall, disease-free, and metastasis-free survival and local control (OS, DFS, MFS, and LC respectively) were 31.5%, 34.1%, 49.5% and 54.1% respectively. Radical resection (R0) was obtained in 84 patients (57.2%), microscopically irradical resection (R1) in 34 patients (23.1%), and macroscopically irradical resection (R2) in 29 patients (19.7%). For patients with a radical resection median OS was 59 months and the 5-year OS, DFS, MFS, and LC were 48.4%, 52.3%, 65.5% and 68.9%, respectively. Radical resection was significantly correlated with improved OS, DFS, and LC (P < 0.001). Patients who received re-irradiation or full-course radiotherapy survived significantly longer (P = 0.043) and longer without local recurrence (P = 0.038) or metastasis (P < 0.001) compared to patients who were not re-irradiated.

Conclusions: Radical resection is the most significant predictor of improved survival in patients with LRRC. Neoadjuvant radio (chemo-) therapy is the best option in order to realize a radical resection. Re-irradiation is feasible in patients who already received irradiation as part of the primary rectal cancer treatment.

Key Words: Rectal cancer • Local recurrence • Multimodality treatment • IORT • Re-irradiation






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