Locally recurrent rectal cancer; long-term outcome of curative surgical and non-surgical treatment of 447 consecutive patients in a tertiary referral centre

Hagemans, J.A.W.; Rees, Jan M. van; Alberda, Wijnand J.; Rothbarth, Joost; Nuyttens, J.; Meerten, Esther van; Verhoef, Cornelis; Burger, Jacobus W. A.

doi:10.1016/j.ejso.2019.10.037

Cited by 49 publications

(55 citation statements)

References 30 publications

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“…[12][13][14] Hagemans et al conducted a retrospective study to evaluate the long-term outcomes of surgical and nonsurgical treatments of patients with LRRC. 15 They demonstrated that the survival rates of patients undergoing surgery were significantly longer compared with the rates of patients receiving nonsurgical treatment. However, R2 resections did not result in a survival benefit compared with nonsurgical treatment in this series.…”

Section: Discussionmentioning

confidence: 99%

<p>Clinical Outcomes and Safety of Different Treatment Modes for Local Recurrence of Rectal Cancer</p>

Tang

Liu

et al. 2020

CMAR

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Objective: Optimal approaches to patients with local recurrence of rectal cancer are unclear in China. This study aimed to evaluaty-30te the clinical outcomes and toxicity associated with different treatment regimens for patients with local recurrence of rectal cancer. Methods: A retrospective chart review of patients with local recurrence of rectal cancer and previous radical surgical treatment between March 2010 and December 2017 with curative intent was performed. Disease-related endpoints included treatment progression-free survival (PFS) and overall survival (OS) using the Kaplan-Meier method. Toxicities were assessed using Common Terminology Criteria for Adverse Events, version 5.0, and complications were scored according to the Clavien-Dindo classification. Results: A total of 71 patients met the inclusion criteria in this study. The recurrence sites were mainly local recurrence in the pelvic cavity and regional lymph node metastasis. Twenty patients received chemoradiotherapy combined with surgery, 10 underwent surgery alone, and others received chemoradiotherapy-alone (n = 27) and chemotherapy-alone (n = 14) treatment. A clear difference was found in PFS between surgery/chemoradiotherapy with surgery and chemoradiotherapy/chemotherapy groups (26.6 months vs 14.1 months, P = 0.033). The PFS of patients in the surgery combined with chemoradiotherapy, surgery alone, and chemotherapy/chemoradiotherapy groups was 65.2 months, 20.2 months, and 14.2 months, respectively (P = 0.042). The multivariate analysis of PFS demonstrated that surgery was an independent factor. The proportion of patients with distant metastases after chemoradiotherapy/chemotherapy was higher than that of patients undergoing surgery (36.6% vs 21.4%, P = 0.179). The OS of patients in the surgery combined with chemoradiotherapy, surgery alone, and chemotherapy/chemoradiotherapy groups was 89.4 months, 66.0 months, and 62.8 months, respectively (P = 0.189). Radiation treatment and surgery did not increase extra severe toxicities. Conclusion: Surgery combined with chemoradiotherapy was a beneficial treatment mode for managing patients with locally recurrent, nonmetastatic rectal cancer. It was associated with better local disease control, no increase in toxicity, and prolonged survival among patients with locally recurrent rectal cancer.

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Section: Discussionmentioning

confidence: 99%

<p>Clinical Outcomes and Safety of Different Treatment Modes for Local Recurrence of Rectal Cancer</p>

Tang

Liu

et al. 2020

CMAR

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“…Furthermore, chemotherapy alone is not effective for controlling pelvic recurrence. It was reported that the 5-year survival rate for R 0 resection ranged from 43% to 60% ( 10 ). However, only a limited number of patients were eligible for R 0 resection.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, distorted anatomical structures and tissue fibrosis from previous irradiation increase the difficulty in surgery ( 6 , 11 ). Besides, extensive resection is typically followed by high morbidity and mortality risks ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes and Prognostic Analysis of Computed Tomography-Guided Radioactive 125I Seed Implantation for Locally Recurrent Rectal Cancer After External Beam Radiotherapy or Surgery

Wang

Jiang

et al. 2021

Front. Oncol.

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BackgroundManagement of locally recurrent rectal cancer (LRRC) after surgery or external beam radiotherapy (EBRT) remains a clinical challenge, given the limited treatment options and unsatisfactory outcomes. This study aimed to assess long-term outcomes of computed tomography (CT)-guided radioactive 125I seed implantation in patients with LRRC and associated prognostic factors.MethodsA total of 101 patients with LRRC treated with CT-guided 125I seed implantation from October 2003 to April 2019 were retrospectively studied. Treatment procedures involved preoperative planning design, 125I seed implantation, and postoperative dose evaluation. We evaluated the therapeutic efficacy, adverse effects, local control (LC) time, and overall survival (OS) time.ResultsAll the patients had previously undergone surgery or EBRT. The median age of patients was 59 (range, 31–81) years old. The median follow-up time was 20.5 (range, 0.89–125.8) months. The median LC and OS time were 10 (95% confidence interval (CI): 8.5–11.5) and 20.8 (95% CI: 18.7–22.9) months, respectively. The 1-, 2-, and 5-year LC rates were 44.2%, 20.7%, and 18.4%, respectively. The 1-, 2-, and 5-year OS rates were 73%, 31.4%, and 5%, respectively. Univariate analysis of LC suggested that when short-time tumor response achieved partial response (PR) or complete response (CR), or D90>129 Gy, or GTV ≤ 50 cm3, the LC significantly prolonged (P=0.044, 0.041, and <0.001, respectively). The multivariate analysis of LC indicated that the short-time tumor response was an independent factor influencing LC time (P<0.001). Besides, 8.9% (9/101) of the patients had adverse effects (≥grade 3): radiation-induced skin reaction (4/101), radiation-induced urinary reaction (1/101), fistula (2/101), and intestinal obstruction (2/101). The cumulative irradiation dose and the activity of a single seed were significantly correlated with adverse effects ≥grade 3 (P=0.047 and 0.035, respectively).ConclusionCT-guided 125I seed implantation is a safe and effective salvage treatment for LRRC patients who previously underwent EBRT or surgery. D90 and GTV significantly influenced prognosis of such patients.

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“…A wide range of different surgical interventions is performed by colorectal surgeons for PRRC, reported in the previous series with various outcomes 4,9,18 . Several classification systems have been proposed in the last thirty years, not always correlated with prognosis and/or radicality of surgical procedures and/or locally residual disease 10‐17 .…”

Section: Discussionmentioning

confidence: 99%

“…In about 50% of pelvic recurrences of rectal cancer (PRRC) no distant metastases occur, and pts generally die of local progression 3 . Therefore, achieving a curative resection of PRRC becomes the only hope for a cure of these patients 4,5 . However, surgery for PRRC is highly demanding, and widely demolitive resections are often required to obtain negative margins 6 .…”

Section: Introductionmentioning

confidence: 99%

A proposal of an updated classification for pelvic relapses of rectal cancer to guide surgical decision‐making

Belli

Sorrentino

Gallino

et al. 2020

Journal of Surgical Oncology

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Background and Objectives Selection of patients affected by pelvic recurrence of rectal cancer (PRRC) who are likely to achieve a R0 resection is mandatory. The aim of this study was to propose a classification for PRRC to predict both radical surgery and disease‐free survival (DFS). Methods PRRC patients treated at the National Cancer Institute of Milan (Italy) were included in the study. PRRC were classified as S1, if located centrally (S1a‐S1b) or anteriorly (S1c) within the pelvis; S2, in case of sacral involvement below (S2a) or above (S2b) the second sacral vertebra; S3, in case of lateral pelvic involvement. Results Of 280 reviewed PRRC patients, 152 (54.3%) were evaluated for curative surgery. The strongest predictor of R+ resection was the S3 category (OR, 6.37; P = .011). Abdominosacral resection (P = .012), anterior exenteration (P = .012) and extended rectal re‐excision (P = .003) were predictive of R0 resection. S3 category was highly predictive of poor DFS (HR 2.53; P = .038). DFS was significantly improved after R0 surgery for S1 (P < .0001) and S2 (P = .015) patients but not for S3 cases (P = .525). Conclusions The proposed classification allows selection of subjects candidates to curative surgery, emphasizing that lateral pelvic involvement is the main predictor of R+ resection and independently affects the DFS.

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Locally recurrent rectal cancer; long-term outcome of curative surgical and non-surgical treatment of 447 consecutive patients in a tertiary referral centre

Cited by 49 publications

References 30 publications

<p>Clinical Outcomes and Safety of Different Treatment Modes for Local Recurrence of Rectal Cancer</p>

<p>Clinical Outcomes and Safety of Different Treatment Modes for Local Recurrence of Rectal Cancer</p>

Long-Term Outcomes and Prognostic Analysis of Computed Tomography-Guided Radioactive 125I Seed Implantation for Locally Recurrent Rectal Cancer After External Beam Radiotherapy or Surgery

A proposal of an updated classification for pelvic relapses of rectal cancer to guide surgical decision‐making

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