Pathologic, anatomic, and biologic factors correlated with local recurrence of colorectal cancer

Abstract

Summary The anatomic patterns of failure after surgical resection of colorectal cancer have been well described and have provided useful clinical information for selecting patients who are at high risk for local-regional failure. Based on these studies, adjuvant pelvic irradiation for rectal cancer patients with disease stages T3,4 and N0,1 has improved local control and survival. Similar studies with adjuvant irradiation for colon cancer patients are still needed and may be underway soon. However, the utility of local irradiation for colon cancer patients may be harder to prove because the incidence of local-regional failure is, in important as pathologic stage in determining the risk of local-regional relapse. Recent adjuvant trials have begun to record margin distance prospectively, have begun to record margin distance prospectively, and data may soon be available regarding this point. Finally, biologic tumor markers, including kinetic and genetic parameters, should be investigated further. Our preliminary data indicate that tumor cell kinetic information can be useful in delineating those patients with advanced rectal cancers who are at increased risk for local failure after pelvic irradiation and surgery. This method may identify those in whom either increased radiation dose levels or accelerated radiation fractionation may be indicated. Furthermore, patterns-of-failure studies incorporating these newer marker studies may possibly add to, or replace, the staging systems currently used to select patients for adjuvant therapy.