Abstract
BackgroundSynchronous liver metastases are detected in approximately 25% of colorectal cancer patients at diagnosis. The rates of local failure and distant metastasis are substantial in these patients, even after undergoing aggressive treatments including resection of primary and metastatic liver tumors. The purpose of this study was to determine whether adjuvant pelvic radiotherapy is beneficial for pelvic control and overall survival in rectal cancer patients with synchronous liver metastasis after primary tumor resection.MethodsAmong rectal cancer patients who received total mesorectal excision (TME) between 1997 and 2006 at Yonsei University Health System, eighty-nine patients diagnosed with synchronous liver metastasis were reviewed. Twenty-seven patients received adjuvant pelvic RT (group S + R), and sixty-two patients were managed without RT (group S). Thirty-six patients (58%) in group S and twenty patients (74%) in group S+R received local treatment for liver metastasis. Failure patterns and survival outcomes were analyzed.ResultsPelvic failure was observed in twenty-five patients; twenty-one patients in group S (34%), and four patients in group S+R (15%) (p = 0.066). The two-year pelvic failure-free survival rates (PFFS) of group S and group S+R were 64.8% and 80.8% (p = 0.028), respectively, and the two-year overall survival rates (OS) were 49.1% and 70.4% (p = 0.116), respectively. In a subgroup analysis of fifty-six patients who received local treatment for liver metastasis, the two-year PFFS were 64.9% and 82.9% (p = 0.05), respectively; the two-year OS were 74.1% and 80.0% (p = 0.616) in group S (n = 36) and group S+R (n = 20), respectively.ConclusionsAdjuvant pelvic RT significantly reduced the pelvic failure rate but its influence on overall survival was unclear. Rectal cancer patients with synchronous liver metastasis may benefit from adjuvant pelvic RT through an increased pelvic control rate and improved quality of life.
Highlights
Synchronous liver metastases are detected in approximately 25% of colorectal cancer patients at diagnosis
The annual disease-specific death rate for colorectal cancer is approximately 40% and liver metastases are found in approximately two-thirds of these patients [2], while synchronous liver metastases are found in 20% to 30% of colorectal cancer patients at initial diagnosis [3]
We investigated the clinical implications of adjuvant pelvic RT following primary tumor resection in rectal cancer patients with synchronous liver metastasis
Summary
Synchronous liver metastases are detected in approximately 25% of colorectal cancer patients at diagnosis. In rectal cancer patients with liver metastasis, conservative management including diverting colostomy resulted in a median survival of approximately three to five months, while resection of the primary tumor increased median survival to fourteen to twenty-four months [4,5,6]. Resection of both the primary and metastatic liver tumors resulted in a median survival of thirty-seven months and a five-year survival rate of 2535% [7,8]. The rate of treatment failure is currently on the rise because patients live longer due to improved efficacy of treatment modalities; pelvic failures or uncontrolled primary tumors may threaten patient survival and quality of life in these cases
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