Abstract
BackgroundTo assess the clinical outcome of chemoradiotherapy with or without surgery for locally recurrent rectal cancer (LRRC) and to find useful and significant prognostic factors for a clinical situation.MethodsBetween January 2001 and February 2009, 67 LRRC patients, who entered into concurrent chemoradiotherapy with or without surgery, were reviewed retrospectively. Of the 67 patients, 45 were treated with chemoradiotherapy plus surgery, and the remaining 22 were treated with chemoradiotherapy alone. The mean radiation doses (biologically equivalent dose in 2-Gy fractions) were 54.6 Gy and 66.5 Gy for the chemoradiotherapy with and without surgery groups, respectively.ResultsThe median survival duration of all patients was 59 months. Five-year overall (OS), relapse-free (RFS), locoregional relapse-free (LRFS), and distant metastasis-free survival (DMFS) were 48.9%, 31.6%, 66.4%, and 40.6%, respectively. A multivariate analysis demonstrated that the presence of symptoms was an independent prognostic factor influencing OS, RFS, LRFS, and DMFS. No statistically significant difference was found in OS (p = 0.181), RFS (p = 0.113), LRFS (p = 0.379), or DMFS (p = 0.335) when comparing clinical outcomes between the chemoradiotherapy with and without surgery groups.ConclusionsChemoradiotherapy with or without surgery could be a potential option for an LRRC cure, and the symptoms related to LRRC were a significant prognostic factor predicting poor clinical outcome. The chemoradiotherapy scheme for LRRC patients should be adjusted to the possibility of resectability and risk of local failure to focus on local control.
Highlights
To assess the clinical outcome of chemoradiotherapy with or without surgery for locally recurrent rectal cancer (LRRC) and to find useful and significant prognostic factors for a clinical situation
An aggressive approach with surgery alone has severe weaknesses in that curative surgery is possible for only 20-30% of patients with locally recurrent rectal cancer (LRRC), because the intrapelvic space is too narrow to perform an R0 resection, and previous treatments, including surgery and radiotherapy, induce extensive fibrosis [3,4]
A relapse after salvage treatment occurred in 41 (61.2%) patients during the follow-up period, and locoregional failure was detected in six patients (9.0%), distant metastasis in 30 patients (44.8%), and both failures in five patients (7.5%)
Summary
To assess the clinical outcome of chemoradiotherapy with or without surgery for locally recurrent rectal cancer (LRRC) and to find useful and significant prognostic factors for a clinical situation. Recent advances in preoperative evaluation, treatment strategies and rectal cancer modalities have lead to better survival outcomes for patients with rectal cancer and a lower incidence of local recurrence [1,2]. Despite such improvements, 6-10% of patients with primary rectal cancer still experience intrapelvic local recurrence with or without distant metastasis [3,4,5]. The purpose of the present study was to assess the clinical outcomes of CRT with or without surgery for patients with LRRC and to find useful and significant prognostic factors for the clinical situation
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