Results of a pooled analysis of IOERT containing multimodality treatment for locally recurrent rectal cancer: Results of 565 patients of two major treatment centres

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• 作者：F.A. Holman^a ; S.J. Bosman^b ; M.G. Haddock^c ; L.L. Gunderson^d ; M. Kusters^a ; ^b ; G.A.P. Nieuwenhuijzen^b ; H. van den Berg^e ; H. Nelson^f ; H.J. Rutten^b ; ^g ; ^{Harm.Rutten@cze.nl}
• 关键词：Locally recurrent rectal cancer ; Multimodality treatment ; Chemo-radiation therapy ; Re-irradiation ; Local re-recurrence ; Intra Operative Electron beam Radiation Therapy
• 刊名：European Journal of Surgical Oncology (EJSO)
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：43
• 期：1
• 页码：107-117
• 全文大小：1085 K
• 卷排序：43

文摘

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 materialsFive 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.ResultsTwo 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.ConclusionsR0 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.