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Outcomes and prognostic factors of multimodality treatment for locally recurrent rectal cancer with curative intent

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Radical management of locally recurrent rectal cancer (LRRC) can lead to prolonged survival. This study aims to assess outcomes and identify prognostic factors for patients with LRRC treated using a multimodality treatment protocol.

Methods

An analysis of a prospectively maintained institutional database of consecutive patients who underwent radical surgical resection for LRRC was performed. Potential prognostic factors were investigated using a Cox proportional hazards model.

Results

Ninety-eight patients were included in this study. A multimodality approach was taken in the majority, including preoperative chemoradiation (78%), intraoperative radiation therapy (47%) and adjuvant chemotherapy (41%). Extended resection was performed where required: bone resection (34%) and lateral pelvic sidewall dissection (31%). The rate of R0 resection was 66%. Estimated rates of 5-year overall survival (OS) and progression-free survival (PFS) were 41.8% (95% CI 32.5–53.7) and 22.5% (95% CI 15.3–33.1). On multivariate analysis, stage III disease at initial primary surgery, a positive margin at initial primary surgery, synchronous or previously resected oligometastases, a lateral or sacral invasive-type pelvic recurrence and the requirement for IORT all predicted for inferior PFS (p < 0.05). Eleven percent of patients subsequently underwent further pelvic surgery for pelvic re-recurrence and had an estimated 5-year OS rate of 54.5% (95% CI 29.0–100.0) from repeat surgery.

Conclusions

Radical multimodality management of LRRC leads to prolonged survival in approximately 40% of patients. Those with sacral or lateral invasive-type recurrence or oligometastatic disease have inferior outcomes and further research is needed to optimise treatment for these groups.

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Authors and Affiliations

  1. Department of Radiation Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, Melbourne, Victoria, 8006, Australia

    Thomas G. Bird, Samuel Y. Ngan & Julie Chu

  2. Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia

    René Kroon

  3. Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia

    Andrew C. Lynch & Alexander G. Heriot

Authors
  1. Thomas G. Bird
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  2. Samuel Y. Ngan
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  3. Julie Chu
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  4. René Kroon
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  6. Alexander G. Heriot
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Corresponding author

Correspondence to Thomas G. Bird.

Ethics declarations

Local institutional review board approval for the study was obtained.

Conflict of interest

The authors declare that they have no conflict of interest.

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Bird, T.G., Ngan, S.Y., Chu, J. et al. Outcomes and prognostic factors of multimodality treatment for locally recurrent rectal cancer with curative intent. Int J Colorectal Dis 33, 393–401 (2018). https://doi.org/10.1007/s00384-018-2985-y

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  • DOI: https://doi.org/10.1007/s00384-018-2985-y

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