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

Abstract

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.

Local recurrence in rectal cancer can be predicted by histopathological factors

“…The cases consisted of patients, without metastases, treated with curative intent for locally recurrent rectal cancer at the Catharina hospital since 1994. 14 The…”

¿se Justifica El Tratamiento De La Recidiva Local Del Cáncer De Recto?

“…Las series son heterogéneas, los protocolos de estudio, las terapias neo o adyuvantes así como el tipo de RL y la cirugía efectuada son extremadamente variados y, por último, el seguimiento es muy variable 29 . Considerando esto, podemos resumir que la principal cirugía efectuada en la operación índice fue la RAP en el 27% (extremos 0-100%); la radioterapia externa preoperatoria fue entregada en el 28% de los casos (extremos 0-100%) y la quimioterapia en el 37% (extremos 0-100%).…”

“…Se ajusta la dosis de 15 a 30 Gy a un área específica y podría mejorar los resultados de la cirugía resectiva lo que es controversial 29 .…”

Late results of treatment and quality of life in women after pelvic exenteration

“…Выделяют 3 типа тазовой экзентерации: переднюю, заднюю и тотальную [5]. Передняя экзентерация вклю-чает удаление тазовых структур передней части полости малого таза (половых органов, мочевого пузыря и мо-…”

“…При местно-распространенных формах и местных рецидивах злокачественных новообразова-ний тазовых органов применяют экзентерацию (эвис-церацию), включающую радикальное иссечение со-держимого таза в той степени, в которой вовлечены в опухолевый процесс тазовые структуры. Операция может включать удаление многочисленных тазовых структур, в том числе мочевого пузыря, матки и ма-точных труб, влагалища, прямой кишки, тазовых со-судов и нервов и тазовой кости [3,4].Выделяют 3 типа тазовой экзентерации: переднюю, заднюю и тотальную [5]. Передняя экзентерация вклю-чает удаление тазовых структур передней части полости малого таза (половых органов, мочевого пузыря и мо-…”