Local Recurrence Of Rectal Cancer Research Articles

Influence of the surgical treatment on local recurrence of rectal cancer: A prospective study (1980–1992)

Influence of the surgical treatment on local recurrence of rectal cancer: A prospective study (1980–1992)

Resection of local recurrence of rectal cancer: results.

Locally recurrent rectal cancer is a difficult clinical problem, and surgical resection can be done only in selected patients. The aims of this study were to evaluate the results of resecting the local recurrence of rectal cancer and to analyze factors that might predict curative re-resection and those that affect survival. Forty-seven patients who underwent resection for locally recurrent rectal cancer formed the basis of the study. Twenty-four were curative in nature, and the others were palliative. There was no operative mortality, and the complication rate was 38%. The median survival of the whole group was 16.5 months. The ability to perform curative resection was found to be the only independent factor associated with improved survival. Female gender is a significant factor associated with curative resection of local recurrence. In patients with curative reresection, local control is up to 87%. It was concluded that resection of local recurrent rectal cancer can achieve good local control and can improve survival in selected patients. The ability to perform curative resection is associated with survival benefit, and female gender is associated with the increased possibility of carrying out curative resection.

Effectiveness of endoluminal sonography in the identification of occult local rectal cancer recurrences.

Local recurrence of rectal cancer after curative surgery appears in 5 to 30 percent of all cases. It is necessary to detect local recurrence in a resectable stage to have an opportunity for curative reintervention or palliative prevention of those symptoms. Because most local recurrences occur extraluminally, conventional follow-up fails to detect them at an early stage. Therefore, a prospective study was performed to assess the diagnostic potential of endorectal and endovaginal ultrasound to detect asymptomatic resectable local recurrence. In 338 patients 721 endoluminal ultrasound examinations were added to routine follow-up of rectal and left colonic cancer, with a mean of 2.1 (range, 1-10) endoluminal ultrasound examinations for each patient. A total of 116 patients (34.3 percent) were shown to have local recurrence, which was suggested by endoluminal ultrasound and proven by endoluminal ultrasound-guided needle biopsy in all cases of unclear pararectal structures that could not be verified by endoscopic biopsy. Digital examination failed to detect local recurrence in 91 patients, endoscopy failed to detect local recurrence in 80 patients, and the levels of tumor markers were normal in 25 patients with confirmed local recurrence. In 33 cases of local recurrence, both digital examination and endoscopy results were normal. Twenty-five patients, in whom carcinoembryonic antigen levels, digital examination, and endoscopy results were normal, underwent potential curative reoperation, with total resection of the local recurrence. All 25 patients were still alive at the end of the study period, and 21 were free from disease. On the other hand, only 6 of 67 patients with local recurrence detectable by conventional follow-up could be operated on with curative intention. Postoperative endoluminal ultrasound is able to detect local recurrence at an earlier and asymptomatic stage and can be verified by endosonography-guided needle biopsy. Routine use in follow-up may raise the ratio of curative retreatment by early detection of extramural local recurrence.

直腸癌に対する低位前方切除後の局所再発の臨床病理学的検討

直腸癌に対する低位前方切除後の局所再発の臨床病理学的検討

Reresection for local recurrence of rectal cancer.

Local recurrence is one of the major reasons that rectal cancer surgery is unsuccessful. The aim of this study was to investigate the surgical characteristics of patients undergoing reresection for local recurrence of rectal cancer. A total of nine patients were enrolled in this study, six of whom underwent total pelvic exenteration, one, posterior exenteration, one, abdominoperineal resection with sacral resection, and one, lymph node dissection alone. The mean operative time was 8 h 15 min, and the mean operative blood loss was 2 325 ml. Although major postoperative complications occurred in four patients (44%), there were no postoperative or hospital deaths. Lateral lymph node metastasis was detected in all four patients whose lateral lymph nodes were dissected or extirpated at the reresection. Two patients survived for more than 5 years without rerecurrence, and the cumulative 5-year survival rate was 26%. The para-aortic lymph nodes were the most common site of first rerecurrence. The results of this study indicate that patients who undergo reresection for local recurrence of rectal cancer are at high risk of devel-oping lateral or para-aortic nodal metastasis. Nevertheless, reresection may be a therapeutic option for the local recurrence of rectal cancer.

Development of an irradiation method of intraoperative radiation therapy for curatively resected rectal cancer

Background. Intraoperative radiation therapy (IORT) has been performed to prevent local recurrence of rectal cancer only when positive margins are suspected. To further reduce local recurrence, we attempted to develop a new IORT irradiation method in which electron beam irradiation is administered as uniformly as possible to the intrapelvic dissection surfaces.

Family disadvantages in early life were associated with depression in adulthood

<b>Objective:</b> To evaluate histological variables correlated with pathological response to chemo-radiotherapy protocols for rectal cancer and with local recurrence and survival. <b>Methods:</b> From 1994 to 2003, 58 patients with rectal...

Raltitrexed (Tomudex™) concomitant with radiotherapy as adjuvant treatment for patients with rectal cancer: preliminary results of phase I studies

Radiotherapy, either alone or in combination with chemotherapy, may reduce local recurrence of rectal cancer following surgery and improve survival of patients with operable and advanced/recurrent/inoperable disease. Chemotherapy with 5-fluorouracil in combination with radiotherapy has been used both before and after surgery; however, the optimum schedule is unclear. In addition, alternative chemotherapy with raltitrexed (Tomudex™) may be more convenient and better tolerated. The preliminary results of three phase I dose-finding studies are described, combining escalating doses of raltitrexed with radiotherapy as pre- or postoperative treatment for operable rectal cancer or as treatment for advanced/inoperable/recurrent rectal cancer. The recommended dose of raltitrexed when combined with adjuvant radiotherapy is likely to be 2.6 mg/m 2 . This is a small dose reduction compared with the dose of raltitrexed for the treatment of advanced colorectal cancer (3.0 mg/m 2); however, toxicity appears to be lower using the pre-operative approach. Neo-adjuvant therapy with raltitrexed plus radiotherapy also demonstrated clinical activity in the pre-operative study, which showed that 22% of patients achieved a complete response and 56% a partial response. Once the recommended dose has been defined in each setting, large-scale studies will be undertaken as appropriate. ©

Microwave coagulation therapy (MCT) for liver metastasis and local recurrence of rectal cancer

A 59-year-old man was operated on with abdominoperineal exsion for rectal cancer. A single liver metastsis, pulmonary metastses and local recurrence of rectal cancer were detected postoperatively. Microwave coagulation therapy (MCT) was performed to the liver metastsis 8 cm in diameter. In the prone position on the CT table under epidural anesthesia, the local recurrence with invasion upon the prostata was coagulated 80 W for 30-45 seconds 7 times with microwave tissue coagulator 1 year after the operation. Area of the coagulated tissue including a part of the prostata invaded by the tumor was about 50% of the local recurrence on the CT images.There was evidence of relapse of the local recurrence after the therapy because complete coagulation was not obtained.Through this case, we report the effect and limitation of the CT guided MCT for local recurrence of rectal cancer.

123I-labelled vasoactive intestinal peptide receptor scintigraphy in patients with colorectal cancer.

Recent studies have shown that various gastrointestinal tumours express substantial amounts of vasoactive intestinal peptide (VIP) receptors. Based on these observations, we have developed a receptor scintigraphy using [123I]VIP as a radioligand. An initial series performed at our institution showed promising potential for visualization of various gastrointestinal adenocarcinomas by means of [123I]VIP. In this article, we now report the results obtained in 80 consecutive patients with colorectal adenocarcinoma. Eighty consecutive patients with histologically verified colorectal cancer underwent scanning by means of [123I]VIP (1 microg, approximately 150 MBq). Thirteen patients were free of tumour after complete resection of Dukes' C cancer, eight patients presented with primary and 14 with locally recurrent tumours but were free of metastases. Ten patients had locally recurrent disease and liver, lung or lymph node metastases. Disease confined to organ metastases (i.e. liver, lung or lymph nodes) was present in 35 patients. The size of the primary or recurrent tumours ranged between 3 and 6 cm, and the size of metastases was between 1 and 13 cm in diameter. Scan results were evaluated independently by two nuclear medicine physicians in a blinded way, and results were then compared with computerized tomography (CT)scans not older than 4 weeks. Seven out of eight primary (87%) and 21 out of 24 (82%) locally relapsing cancers were imaged with [123I]VIP. Negative VIP scans were obtained in all 13 patients in whom the cancers had been curatively resected. All patients with lymph node metastases showed positive VIP scans (four out of four), and positive scans were obtained in 25 out of 28 (89%) patients with liver metastases and in two out of three cases with lung metastases. In four patients with relapsing cancer, the VIP scan indicated the presence of disease before CT, and in two patients the diagnosis of scar tissue instead of a local recurrence of rectal cancer as suggested by CT could be established. We conclude that [123I]VIP receptor scanning is a sensitive method for radioimaging of colorectal cancer with the potential to provide valuable additional information to conventional radiological methods.

Treatment of Local Recurrence of Rectal Cancer

Background: Treatment of local recurrence of rectal cancer remains a challenge. Preoperative irradiation and total mesorectal excision halve the risks of local failure, but increase morbidity and even mortality. The results of re-resection of recurrent rectal cancer suggest need to reexamine therapeutic strategies for initial treatment. Methods: Seventy-one patients operated on for rectal carcinoma without radiotherapy developed local recurrence (29 with metastatic disease). Thirty underwent a curative re-resection (8 had combined resection of metastases). Results: The incidence of asymptomatic recurrence was higher after anterior resection (38%) than after abdominoperineal resection (16%). The actuarial 5-year survival rate was 19%; 28% in asymptomatic patients and 8% in symptomatic ( P = 0.04). Conclusions: Early detection of recurrence of rectal cancer leads to an improved re-resection rate and survival. In patients who did not undergo radiotherapy at the time of the original resection, re-resection can be achieved safely. The place for radiation in the treatment of rectal cancer must be redefined.

Surgery for local pelvic recurrence after resection of rectal cancer

This retrospective study evaluated outcome with regard to procedure, local control, and survival after curative surgical resection with and without preoperative radiotherapy for local pelvic recurrence. A total of 58 consecutive patients with local pelvic recurrence of rectal cancer after previous curative resection for primary tumors were reviewed. Of these, 36 underwent both initial resection and follow-up in our department; the remaining 22 had initial surgery and follow-up elsewhere. Of the 58 patients 27 underwent curative re-resection, 9 had palliative resection, and 22 were treated by conservative therapy. Among the 27 patients with curative resection 17 received preoperative radiotherapy (40 Gy) plus surgery and 10 surgery only. No patients were lost to follow-up; median follow-up time was 36.3 months. The overall rate of curative resection was 46.6%: 55.6% in our own follow-up group and 31.8% in the others. With regard to surgical procedure, abdominoperineal resection (APR) with or without sacral resection was standard following previous low anterior resection, and total pelvic exenteration (TPE) with or without sacral resection was common following APR. There was a high incidence of morbidity (71.4%) after TPE. Re-recurrence was observed in 12 (44.4%) after curative re-resection. There was local re-recurrence in 6 (22.2%). The local re-recurrence rate was 11.8% (n = 2) with radiotherapy plus surgery, and 40.0% (n = 4) with surgery alone. The estimated 5-year survival following curative re-resection was 45.6% (61.2% with radiotherapy plus surgery, 29.6% with surgery alone). Both survival and local control with radiotherapy plus surgery tended to be better than with surgery alone. Thus, in selected patients pelvic local recurrence of rectal cancer can be re-resected curably by APR or TPE (with or without sacral resection) combined with preoperative radiotherapy.

Percutaneous microwave tumor coagulator for local tumor recurrence of rectal cancer

The possible use of percutaneous microwave tumor coagulator (PMCT) by using CT for local tumor recurrence of rectal cancer was studied in this paper. Preliminary study was performed using adult Landrace pig and we applied the coagulation time for 3 minutes. The CT guided PMCT was performed for patient with local abdomino-perineal excision. The tumor in the pelvic space were observed on CT images. With patient in the prone position on the CT table, a 14-gauge needle was used to penetrate the tumor under epidural and local anesthesia.PMCT was performed with an output of 60 watts for 60 seconds at a time. Effects of the PMCT were evaluated by CT images obtained three months after the therapy, there was no evidence of growth for the tumor on the CT images. Clinical symptoms disappered soon after the therapy, and no major complication was observed.Results of this study suggests that the CT guided PMCT therapy may be useful for local recurrence of rectal cancer.

Study on the causes of local recurrence of rectal cancer after curative resection:analysis of 213 cases.

AIM:To study the local recurrent rate and the causes of rectal cancer after surgery.METHODS:The clinicopathological data of 213 rectal cancer patients and the follow-up information were analyzed. The overall recurrent rate and the recurrent rates from different surgical appreaches were calculated. The main causes of recurrence were investigated.RESULTS:Among the 213 cases, 73 (34.27%) had local recurrence. The recurrent time ranged from 3 months to 62 months after the first operation. Most of the recurrence (65/73, 89.04%) occurred within 3 years after operation.CONCLUSION:Local recurrence had no significant correlation with surgical methods or pathological types, but closely related to Dukes' stages, location of primary tumors and the length of the distal rectum resected. Early resection and a wide tumor free resection margin are key factors to prevent local recurrence.

直腸癌局所再発に対するマイクロ波凝固療法の試み

直腸癌局所再発に対するマイクロ波凝固療法の試み

Clinicopathological staging and management of colorectal cancer. Perioperative radiation therapy.

The use of radiotherapy, as a complementary procedure prior to surgery for immobile, nonresectable, rectal cancers or as an adjuvant treatment in patients with mobile rectal cancer is discussed. Locally nonresectable rectal cancer can be resected after prolonged preoperative radiotherapy. The proportion of patients possible to cure after this prolonged treatment is not precisely known, mainly due to differences in the criteria for nonresectability. Literature data show that between 35% and 80% can undergo resection for cure, and 25% to 40% can be long-term disease-free survivors. Moreover, the role of chemotherapy in combination with radiotherapy in this group is not yet settled owing to the lack of convincing data from randomized trials. Data from the literature clearly indicate that preoperative radiotherapy in patients with mobile rectal cancer is superior to postoperative irradiation. Provided the dose is sufficiently high, a relative reduction in the local recurrence rate of 60% in combination with "standard surgery" is to be expected, and this reduction increases long-term survival. An important question is the role of adjuvant radiotherapy together with "more optimized surgery." It is likely that the local recurrence rate will decrease with the same magnitude, indicating that local recurrent rectal cancer in patients with mobile rectal cancer can be more or less eradicated if optimized surgery is combined with preoperative radiotherapy. With proper timing and treatment technique, the adverse effects on surrounding tissues, both immediate and late, can be kept acceptably low.

Association between age and local recurrence of rectal cancer: results from a retrospective study of 902 patients.

Due to the ageing of the general population, there has been a relative increase of elderly patients with rectal cancer. The relation between age and the risk of local recurrence after apparently curative surgery for cancer of rectum and rectosigmoid was studied in a retrospective study of 902 patients, diagnosed from 1984 through 1991 in the southwestern part of the Netherlands. Three age-groups were defined: 15-64 (n = 328), 65-74 (n = 327) and 75 and over (n = 247). After exclusion of postoperative deaths and controlling for unrelated causes of death, 5-year survival rates were similar in the three age-groups (70%, 71% and 75%, respectively). Local recurrence rates, however, decreased with age from 23% to 18% and 14%, respectively. In multivariate analysis, the hazard ratios were 1, 0.84 and 0.66, respectively. These results suggest that local recurrence occurs less frequently in the elderly, which needs confirmation from prospective studies and warrants consideration in decisions about the use of adjuvant treatment.

Randomised trial of surgery alone versus surgery followed by radiotherapy for mobile cancer of the rectum

Background Although surgery is the treatment of choice for rectal cancer, local recurrence is common even after apparently curative resection. We aimed to assess the role of postoperative radiotherapy in reducing rates of local recurrence, and improving disease-free and overall survival in patients with mobile Dukes' stage B and C rectal cancers.Methods We carried out a prospective, randomised trial of surgery alone (n=235) versus surgery followed 4-6 weeks later by radiotherapy (n=234), of 40 Gy in 20 fractions of 2 Gy over 4 weeks. The 469 patients, from 46 hospitals in the UK and the Republic of Ireland, were randomised between 1984 and 1989, and followed up for a minimum of 5 years or to death.Findings 284 patients died, 145 of 235 allocated surgery alone and 139 of 234 allocated postoperative radiotherapy. The hazard ratio for overall survival was 0.84 (95% CI 0.65-1.07, p=0.17). At 5 years' follow-up 79 patients who received surgery alone and 48 who received postoperative radiotherapy had had local recurrence (hazard ratio 0.54 [0.38-0.77], p=0.001). The corresponding numbers with distant recurrence were 83 and 75 (hazard ratio 0.85 [0.63-1.114], p=0.18). The hazard ratio for disease-free survival was 0.85 (0.65-1.08; p=0.18). Radiotherapy was generally well tolerated; assessment of late events showed serious late bowel complications to be rare and not significantly increased after radiotherapy, even when this followed anterior resection.Interpretation Our results have provided further evidence of the ability of postoperative radiotherapy to delay and prevent local recurrence of rectal cancer. Although the local recurrence rate in the control group is in keeping with other multicentre trials of the mid to late 1980s, it is undoubtedly higher than would be regarded as acceptable now. The combination of larger trials required to provide definitive answers on the impact that postoperative radiotherapy will have on survival.

Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer

Background Survival rates after surgery for rectal cancer remain at about 40% at 5 years from diagnosis, The aim of this study was to find out whether local recurrence rate could be reduced and survival increased by a moderately high dose of preoperative radiotherapy in patients with locally advanced, but otherwise operable, carcinoma of the rectum.Methods We carried out a prospective randomised trial of surgery alone (n=140) versus surgery preceded by 40 Gy radiotherapy (n=139) given in 20 fractions of 2 Gy over 4 weeks. The patients, from 20 regional centres throughout the UK, were enrolled between 1981 and 1989, and followed up for a minimum of 5 years or to death.Findings 217 patients died, 114 of 140 allocated surgery alone and 103 of 139 allocated preoperative radiotherapy: median survival limes were 24 months and 31 months, respectively. The hazard ratio for overall survival was 0.79 (95% CI 0.60-1.04, p=0.10). At 5 years' follow-up 65 patients allocated surgery alone and 50 who received preoperative radiotherapy bad local recurrence (hazard ratio 0.68 [0.47-0.98], p=0.04); the corresponding numbers of patients with distant recurrence were 67 and 49 (hazard ratio 0.66 [0.46-0.95], p=0.02). There was a significant benefit of radiotherapy on disease-free survival (hazard ratio 0.76 [0.58-1.0], p=0.05). There was no increase in postoperative or late complications in the radiotherapy group,Interpretation Our results provide further evidence that preoperative radiotherapy can reduce the rate of local recurrence of rectal cancer in patients with locally advanced disease. However, survival results are still equivocal, and so we must await the results of a metaanalysis of all radiotherapy trials from which precise and definitive results, particularly for survival, may be obtained.

Local recurrence of rectal cancer: evaluation with F-18 fluorodeoxyglucose PET imaging.

Positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) is a useful technique for detection of malignancy. The purpose of this study was to determine if FDG-PET scanning using visual and quantitative analyses can identify patients with recurrent colorectal tumor following abdominoperineal resection. Eighteen patients were evaluated for possible local recurrence of rectal carcinoma following abdominoperineal resection. The clinical presentation included rising carcinoembryonic antigen levels (n = 5), increasing size of a presacral mass on computed tomography or magnetic resonance (n = 13), or local symptoms (n = 3). Axial PET images of the pelvis were obtained following an injection of 10 mCi of FDG prior to biopsy. Quantitative analysis was performed by calculation of a standardized uptake ratio (SUR), and the images were interpreted by two radiologists in consensus. FDG-PET findings were correlated with histological or cytological findings and with the clinical outcome. Recurrent malignancy was confirmed in 13 patients by surgery (n = 8) or percutaneous biopsy (n = 5). Benign lesions were confirmed in five patients by surgery (n = 1), biopsy (n = 3), or clinical follow up (n = 1). Visual analysis of the FDG-PET data had a sensitivity of 92.3% (12/13) for recurrent disease (95% confidence limits; 63.9%, 99.8%) and a specificity of 80% (4/5; 95% confidence limits; 28.3%, 99.4%). SUR values were significantly higher in malignant lesions (range = 2.92-19.74, mean = 6.89) than in benign ones (range = 1.40-3.47, mean = 1.96; p = 0.002). FDG-PET is an accurate technique for detection of locally recurrent colorectal carcinoma. Visual analysis is equivalent to quantitative analysis for detection of disease.