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Kusters, M.; Valentini, V.; Calvo, F.A.; Krempien, R.; Nieuwenhuijzen, G.A.; Martijn, H.; ... ; Rutten, H.J.T. (2010)

Results of European pooled analysis of IORT-containing multimodality treatment for locally advanced rectal cancer: adjuvant chemotherapy prevents local recurrence rather than distant metastases

Article / Letter to editor
Background: The purpose of this study is to analyze the pooled results of multimodality treatment of locally advanced rectal cancer (LARC) in four major treatment centers with particular expertise in intraoperative radiotherapy (IORT). Patients and methods: A total of 605 patients with LARC who underwent multimodality treatment up to 2005 were studied. The basic treatment principle was preoperative (chemo) radiotherapy, intended radical surgery, IORT and elective adjuvant chemotherapy (aCT). In uni- and multivariate analyses, risk factors for local recurrence (LR), distant metastases (DM) and overall survival (OS) were studied. Results: Chemoradiotherapy lead to more downstaging and complete remissions than radiotherapy alone (P < 0.001). In all, 42% of the patients received aCT, independent of tumor-node-metastasis stage or radicality of the resection. LR rate, DM rate and OS were 12.0%, 29.2% and 67.1%, respectively. Risk factors associated with LR were no downstaging, lymph node ...Show moreBackground: The purpose of this study is to analyze the pooled results of multimodality treatment of locally advanced rectal cancer (LARC) in four major treatment centers with particular expertise in intraoperative radiotherapy (IORT). Patients and methods: A total of 605 patients with LARC who underwent multimodality treatment up to 2005 were studied. The basic treatment principle was preoperative (chemo) radiotherapy, intended radical surgery, IORT and elective adjuvant chemotherapy (aCT). In uni- and multivariate analyses, risk factors for local recurrence (LR), distant metastases (DM) and overall survival (OS) were studied. Results: Chemoradiotherapy lead to more downstaging and complete remissions than radiotherapy alone (P < 0.001). In all, 42% of the patients received aCT, independent of tumor-node-metastasis stage or radicality of the resection. LR rate, DM rate and OS were 12.0%, 29.2% and 67.1%, respectively. Risk factors associated with LR were no downstaging, lymph node (LN) positivity, margin involvement and no postoperative chemotherapy. Male gender, preoperatively staged T4 disease, no downstaging, LN positivity and margin involvement were associated with a higher risk for DM. A risk model was created to determine a prognostic index for individual patients with LARC. Conclusions: Overall oncological results after multimodality treatment of LARC are promising. Adding aCT to the treatment can possibly improve LR rates.Show less
chemotherapy intraoperative radiotherapy locally advanced rectal carcinoma multimodality treatment total mesorectal excision electron boost radiotherapy preoperative chemoradiation colorectal-cancer intraoperative irradiation circumferential margin resection survival surgery combination
All authors
Kusters, M.; Valentini, V.; Calvo, F.A.; Krempien, R.; Nieuwenhuijzen, G.A.; Martijn, H.; Doglietto, G.B.; Valle, E. del; Roeder, F.; Buchler, M.W.; Velde, C.J.H. van de; Rutten, H.J.T.
Date
2010-06-30
Journal
Annals of Oncology
Volume
21
Issue
6
Pages
1279 - 1284
DOI
doi:10.1093/annonc/mdp501