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, Michael Haddock, L. L. Gunderson, M. Kusters, G. A P Nieuwenhuijzen, H. van den Berg, Heidi Nelson, H. J. Rutten

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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.

Original languageEnglish (US)
Pages (from-to)107-117
Number of pages11
JournalEuropean Journal of Surgical Oncology
Volume43
Issue number1
DOIs
StatePublished - Jan 1 2017

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Keywords

  • Chemo-radiation therapy
  • Intra Operative Electron beam Radiation Therapy
  • Local re-recurrence
  • Locally recurrent rectal cancer
  • Multimodality treatment
  • Re-irradiation

ASJC Scopus subject areas

  • Surgery
  • Oncology

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