Oncological Outcomes of Locally Recurrent Rectal Cancer Treated With Curative Intent: A Single Center Retrospective Cohort Study.

Treatment and survival of locally recurrent rectal cancer: A cross-sectional population study 15 years after the Dutch TME trial

BackgroundIn current practice, rates of locally recurrent rectal cancer (LRRC) are low due to the use of the total mesorectal excision (TME) in combination with various neoadjuvant treatment strategies. However, the literature on LRRC mainly consists of single- and multicenter retrospective cohort studies, which are prone to selection bias. The aim of this study is to provide a nationwide, population-based overview of LRRC after TME in the Netherlands.Patients and MethodsIn total, 1431 patients with nonmetastasized primary rectal cancer diagnosed in the first six months of 2015 and treated with TME were included from the nationwide, population-based Netherlands Cancer Registry. Data on disease recurrence were collected for patients diagnosed in these 6 months only. Competing risk cumulative incidence, competing risk regression, and Kaplan–Meier analyses were performed to assess incidence, risk factors, treatment, and overall survival (OS) of LRRC.ResultsThree-year cumulative incidence of LRRC was 6.4%; synchronous distant metastases (LRRC-M1) were present in 44.9% of patients with LRRC. Distal localization, R1–2 margin, (y)pT3-4, and (y)pN1-2 were associated with an increased LRRC rate. No differences in LRRC treatment and OS were found between patients who had been treated with or without prior n(C)RT. Curative-intent treatment was given to 42.9% of patients with LRRC, and 3-year OS thereafter was 70%.ConclusionsNationwide LRRC incidence was low. A high proportion of patients with LRRC underwent curative-intent treatment, and OS of this group was high in comparison with previous studies. Additionally, n(C)RT for primary rectal cancer was not associated with differences in treatment and OS of LRRC.

Surgery is the only curative treatment in patients with locally recurrent rectal cancer (LRRC). The aim of this study was to evaluate the outcome and the prognostic factors of tumour-free resection margin (R0) and overall survival (OS) in LRRC. Consecutive LRRC patients observed between 1987 and 2005 in three Italian university hospitals were evaluated. Survival curves were estimated using the Kaplan-Meier method and compared with the log-rank test. In order to identify factors associated with both R0 resection and OS, a logistic regression analysis was performed in patients who underwent surgery with curative intent. Out of 150 patients with LRRC, 107 underwent surgery, but since 7 were found to have unresectable disease only 100 underwent surgical resection. Of them, 51 underwent radical and 49 extended resection. Sixty of the 107 patients underwent multimodality treatment. In 61 patients, R0 resection was achieved. Median OS after surgery was 43.4months. In patients, who had surgery with curative intent, independent variables associated with R0 resection were: surgery for the primary tumour performed in other hospitals (p=0.042) extended resection (p=0.025) and use of positron emission tomography (PET) as a staging modality (p=0.03). Independent variables associated with OS were: post-operative radiotherapy (p=0.004), stage of the primary tumour (p=0.004), R0 resection (p=0.00001), and use of PET (0.02). Resection for LRRC results in improved survival. Other than the well-known prognostic factors R0 resection and OS, PET scan has an independent impact both on OS and R0 resection. It should therefore be included in routine clinical practice when staging LRRC.

BackgroundIn the Netherlands, use of neoadjuvant radiotherapy for rectal cancer declined after guideline revision in 2014. This decline is thought to affect the clinical nature and treatability of locally recurrent rectal cancer (LRRC). Therefore, this study compared two national cross-sectional cohorts before and after the guideline revision with the aim to determine the changes in treatment and survival of LRRC patients over time. MethodsPatients who underwent resection of primary rectal cancer in 2011 (n = 2094) and 2016 (n = 2855) from two nationwide cohorts with a 4-year follow up were included. Main outcomes included time to LRRC, synchronous metastases at time of LRRC diagnosis, intention of treatment and 2-year overall survival after LRRC. ResultsUse of neoadjuvant (chemo)radiotherapy for the primary tumour decreased from 88.5% to 60.0% from 2011 to 2016. The 3-year LRRC rate was not significantly different with 5.1% in 2011 (n = 114, median time to LRRC 16 months) and 6.3% in 2016 (n = 202, median time to LRRC 16 months). Synchronous metastasis rate did not significantly differ (27.2% vs 33.7%, p = 0.257). Treatment intent of the LRRC shifted towards more curative treatment (30.4% vs. 47.0%, p = 0.009). In the curatively treated group, two-year overall survival after LRRC diagnoses increased from 47.5% to 78.7% (p = 0.013). ConclusionPrimary rectal cancer patients in 2016 were treated less often with neoadjuvant (chemo)radiotherapy, while LRRC rates remained similar. Those who developed LRRC were more often candidate for curative intent treatment compared to the 2011 cohort, and survival after curative intent treatment also improved substantially.

Treatment with curative intent of stage III non-small cell lung cancer patients of 75 years: A prospective population-based study

Introduction Negative resection margin (R0) is strongly associated with long term outcomes after surgical resection for locally recurrent rectal cancer (LRRC). The aim of this study was to evaluate the association of microscopic vascular invasion (V1) with probability of R0 resection and disease-free survival (DFS) when performing resection of LRRC with curative intent. Method Study design: Retrospective observational study. Participants: Patients operated with curative intent for LRRC at the Karolinska University Hospital from January 2003 until December 2017. Data were retrieved from medical records. Outcome measures were R status and DFS. Result Overall, 126 patients were operated for LRRC with curative intent. R0 resection was achieved in 96 patients (76%). The absence or presence of V1 was stated in the pathology report in 73 patients (58%). Of those 41 (56 %) were reported as V1 and 32 (44 %) as V0. The relative risk of R1 resection was 41 % when V1 was present and 0.0 % in the absence of V1 (P<0.001). Presence of V1 in the LRRC specimen was also associated with impaired DFS (P=0.05). Discussion Microscopic vascular invasion in LRRC is a significant risk factor for R1 resection and poor survival after resection with curative intent.

BackgroundInguinal lymph node metastases (ILNM) from rectal adenocarcinoma are rare and staged as systemic disease. This study aimed to provide insight into the treatment and prognosis of ILNM from rectal adenocarcinoma.MethodsAll patients with a diagnosis of synchronous or metachronous ILNM from rectal adenocarcinoma between January 2005 and March 2017 were retrospectively reviewed.ResultsThe study identified 27 patients with ILNM (15 with synchronous and 12 with metachronous disease). After discussion by a multidisciplinary tumor board, 19 patients were treated with curative intent, 17 of whom underwent inguinal lymph node dissection. Of the 17 patients, 12 had locally advanced rectal cancer (LARC) with isolated ILNM, 3 had LARC and metastases elsewhere, and 2 had locally recurrent rectal cancer (LRRC). The median overall survival (OS) for all the patients treated with curative intent was 27 months [95% confidence interval (CI) 11.6–42.4 months], with a 5-year OS rate of 34%. The median OS for the patients with LARC and isolated ILNM (n = 12) was 74 months (95% CI 18.0–130.0 months), with a 5-year OS rate of 52%. All the patients with metastases elsewhere (n = 3) or LRRC (n = 2) experienced recurrent systemic disease. Eight patients were treated with palliative intent. The median OS for this group was 13 months (95% CI 1.9–24.1 months), with a 3-year OS rate of 0%.ConclusionClinicians should not consider ILNM as an incurable systemic disease. Patients with primary rectal cancer and solitary ILNM who were eligible for curative surgical treatment had a 5-year survival rate of 52%. The prognosis for patients with additional systemic metastases or LRRC is worse, and the benefit of surgery is unclear.

730 Background: The ‘Beyond TME’ Collaborative identified LRRC as a complex problem requiring multidisciplinary consultation and specialized surgical care. Aggressive en bloc resection of LRRC at specialized cancer centers is associated with 5y survival rates of 25-50%. However, skepticism persists that LRRC can be cured given the lack of published longer-term survival data. We investigated the oncologic outcomes at 10y following resection of LRRC and sought relevant clinicopathologic prognostic variables. Methods: The study cohort consists of 52 consecutive patients (31M, 21F) who underwent LRRC resection at our center between 09/1997 and 08/2005. En bloc sacrectomy was performed in 30 patients (58%) with the goal of achieving complete margin negative (R0) resection. At the time of LRRC resection, 46 of 52 patients had isolated LRRC (M0), and 6 had potentially resectable distant metastasis (M1). Patients were followed with H&P, CT-CAP q4mos X2y, q6mos X3y, then annually. Results: At last follow-up (f/u), 32 patients had died of rectal cancer, 1 died of other causes, 4 were alive with rectal cancer, and 15 (30%) were alive cancer-free. For the entire cohort of 52 patients, median f/u time was 44mos (4-162) and overall survival (OS) was 42% at 5y, 37% at 10y, median 43mos. In the group who were alive at last f/u (N = 19), median f/u time was 123mos (45-162). Prognostic variables for OS in univariate analysis included: m status, resection margin status, receipt of systemic Rx, and receipt of radiotherapy. All patients who had M1 disease at the time of LRRC resection died of recurrent cancer at a median of 21mos (4-46). In the 46 M0 patients, OS was 47% at 5y, 42% at 10y, median 50mos; furthermore, disease-free survival (DFS) was 38% at 5y, 38% at 10y, median 39mos. In patients who had R0 resection (n = 41), OS was 51% at 5y, 45% at 10y, median 72mos. Preoperative chemotherapy at the time of primary presentation (n = 26) or before resection of LRRC (n = 20) was associated with significantly improved prognosis ( p= 0.004, p= 0.03, respectively). Conclusions: Complete resection of LRRC was associated with durable survival in approximately 40% of patients, with plateauing of survival curves after 5y. Preoperative therapy of LRRC may improve survival.

Pathological determinants of outcome following resection of locally advanced or locally recurrent rectal cancer

Objective To evaluate the efficacy of computed tomography (CT) image-guided 125I radioactive seed implantation for locally recurrent rectal cancer (LRRC), and to analyze the relationship between the dosimetry and prognosis. Methods A retrospective analysis was performed on the clinical data of 36 patients with LRRC who received CT image-guided 125I seed implantation in our hospital from 2003 to 2011. Dosimetric verification was performed using CT scan immediately after 125I seed implantation. The D90, D100, V100, and V150 values were evaluated. In all the patients, the median activity of seeds was 0.7 mCi (0.4-0.8 mCi) and the median number of implanted seeds was 74(33-137). The local control (LC) and overall survival (OS) rates were calculated using the Kaplan-Meier method. The log-rank test and Cox regression model were used for the univariate and multivariate analyses, respectively. Results The median OS time was 16.2 months (95% CI=13.5-18.9 months). The median LC time was 10.0 months (95% CI=6.2-13.8 months). The D90 and V100 values were (118.6±25.1) Gy and (90.0±0.3)%, respectively. The univariate analysis suggested that D90 was correlated with the LC time (P=0.048) and V100 was correlated with the OS time (P=0.035). The multivariate analysis showed that a V100 value higher than 90% was a prognostic factor of OS (P=0.044). Conclusions In the treatment of LRRC using CT image-guided 125I radioactive seed implantation, a D90 value larger than 140 Gy and a V100 value higher than 90% in the postoperative verification plan help improve the LC and OS rates. The D90 and V100 values in the postoperative verification plan may predict treatment outcomes in patients. Key words: Neoplasm recurrent, rectal/radioactive seed implantation; Treatment outcome; Dosimetry

Timing of Androgen Deprivation Treatment for Men with Biochemical Recurrent Prostate Cancer in the Context of Novel Therapies.

Patients with locally recurrent rectal cancer (LRRC) frequently present with either synchronous metastases or a history of metastases. This study was conducted to evaluate whether LRRC patients without metastases have a different oncological outcome compared to patients with a history of metastases treated with curative intent or patients with potentially curable synchronous metastases. All consecutive LRRC patients who underwent intentionally curative surgery between 2005 and 2017 in a large tertiary hospital were retrospectively reviewed and categorized as having no metastases, a history of (curatively treated) metastases or synchronous metastases. Patients with unresectable distant metastases were excluded from the analysis. Of the 349 patients who were analysed, 261 (75%) had no metastases, 42 (12%) had a history of metastases and 46 (13%) had synchronous metastases. The 3-year metastasis-free survival was 52%, 33% and 13% in patients without metastases, with a history of metastases, and with synchronous metastases, respectively (P<0.001) A history of metastases did not influence overall survival (OS), but there was a trend towards a worse OS in patients with synchronous metastases compared with patients without synchronous metastases (hazard ratio 1.43; 95% CI 0.98-2.11). LRRC patients with a history of curatively treated metastases have an OS comparable to that in patients without metastases and should therefore be treated with curative intent. However, LRRC patients with synchronous metastases have a poor metastasis-free survival and worse OS; in these patients, an individualized treatment approach to observe the behaviour of the disease is recommended.

Colorectal peritoneal carcinomatosis (PC) is preferably treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Peritoneal recurrence of disease after treatment can occur without distant metastases, with a variety of treatment options. This study aimed to evaluate the management of isolated peritoneal recurrence after primary CRS-HIPEC. In two tertiary referral centers, all patients who underwent CRS-HIPEC for colorectal PC between 2004 and 2015 and who developed isolated peritoneal recurrences were retrospectively evaluated. Location, treatment of peritoneal recurrences, and curative or palliative treatment intent were reported, and univariable and multivariable Cox regression analysis and survival analyses were performed. Of 414 patients treated with CRS-HIPEC for colorectal PC, 106 patients (26%) developed isolated peritoneal recurrence. Forty-three patients (41%) were treated with curative intent and 63 (59%) were treated with palliative intent. Median overall survival (OS) in the patients treated with curative intent was 24.7months (interquartile range [IQR] 12.1-61.7), compared with 7.6months (IQR 2.5-15.9) in those treated with palliative intent (p < 0.001). In the patients treated with curative CRS (n = 17) and curative second CRS-HIPEC (n = 15), median OS was 51.7months (IQR 14.4-NA) and 29.0months (IQR 18.1-63.0), respectively (p = 0.620). The latter group had a significantly higher region count (median 1 vs. 3; p < 0.001). Postoperative complications and hospital stay did not significantly differ between first and second CRS-HIPEC. After CRS-HIPEC for colorectal cancer, approximately one of four patients will develop isolated peritoneal recurrences. A substantial amount of these patients can be safely treated with curative intent yielding long-term survival.

Palliative management of patients with locally recurrent rectal cancer: Clinical presentation, treatment strategies, and overall survival.

Purpose To determine the influence of location, extent of tissue invasion, and tumor morphology at MRI on the resectability of locally recurrent rectal cancer (LRRC) and postresection oncologic outcomes of LRRC. Materials and Methods This retrospective observational study included consecutive patients diagnosed with LRRC who underwent surgery with curative intent at the Catharina Hospital Eindhoven and Karolinska University Hospital Stockholm between January 2003 and December 2017. Two expert radiologists reviewed available MR images while adhering to a standardized reviewing checklist. The effect of pelvic structure involvement, tumor morphology on the primary outcome of resection margin status, and secondary outcomes of overall survival and disease-free survival were assessed using univariable and multivariable logistic regression and Cox proportional hazard analyses. Results The final analysis included 328 patients with LRRC (mean age ± SD, 64.9 years ± 9.6; 126 female, 202 male). Resection margins were negative in 217 (66.2%) patients and positive in 111 patients (33.8%). Tumor size, tumor type, and border type on MR images were all associated with resectability. Central recurrences were associated with the lowest likelihood of positive resection margins (odds ratio [OR], 0.45; 95% CI: 0.28, 0.71; P < .001), whereas lateral recurrences were associated with the highest likelihood (OR, 2.00; 95% CI: 1.25, 3.19: P = .004). Similarly, central recurrences were associated with better disease-free survival compared with lateral recurrences (hazard ratio [HR], 0.69; 95% CI: 0.53, 0.90; P = .006 vs HR, 1.49; 95% CI: 1.14, 1.94; P = .003, respectively). Similar findings were observed after correcting for resection margin status. Conclusion Standardized MRI assessment of tumor characteristics in patients with LRRC resulted in the identification of specific prognostic factors. Central compartment involvement and well-defined tumors were associated with improved prognosis, whereas lateral compartment involvement and fibrotic spiculated tumors were associated with a worse prognosis after surgical resection. Keywords: Rectum, MR-Imaging, Abdomen/GI, Oncology, Surgery, Locally Recurrent Rectal Cancer, Tumor Biology Supplemental material is available for this article. © RSNA, 2025.