Recurrent rectal cancer within the pelvis. A multicenter analysis of 123 patients and recommendations for adjuvant radiotherapy.
OBJECTIVE
Recommendations for radiation ports in adjuvant radiation therapy for rectal cancer are mainly based on analysis of recurrence patterns. To evaluate whether changes in surgical technique have influenced this pattern of recurrence, a multicenter retrospective analysis was carried out on a patient population treated recently.


METHODS
123 patients were evaluated with the help of a CT-based self-developed 3-D data file system and an extensive questionnaire. Major inclusion criteria (one sufficient) for eligibility were: histological confirmation, clear bone destruction, and a positive PET scan, or at least three minor criteria: progressive soft tissue mass, invasion of adjacent organs on follow-up CT or MRI, rising tumor markers, and typical appearance in cross-sectional imaging. Clinical or serologic signs of inflammation were exclusion criteria.


RESULTS
Initially, 54% of the evaluated patients were N0; in the remainder, N1 and N2 were distributed evenly. Initial T-category was T1 in 2%, T2 in 24%, T3 in 60%, and T4 in 13%, the male-to-female ratio was 2:1. Recurrent tumors were mainly situated in the posterior part of the bony pelvis as displayed in the figures. When abdominoperineal resection was compared to low anterior resection as primary operation, there was a significant difference in extension of recurrent tumors in the inferior parts of the pelvis (p<0.025 in all statistical tests applied), whereas no significant difference was found in the superior parts of the pelvis.


CONCLUSIONS
Based on these results, a modest field size reduction in adjuvant radiotherapy for rectal cancer seems feasible, offering the perspective of a reduction in acute and late side effects.
Höcht
Stefan
S
Department of Radiation Oncology and Radiotherapy, Charité Campus Benjamin Franklin, Berlin, Germany. hoecht@medizin.fu-berlin.de
Hammad
Riad
R
Thiel
Hans-Joachim
HJ
Wiegel
Thomas
T
Siegmann
Alessandra
A
Willner
Jochen
J
Wust
Peter
P
Herrmann
Thomas
T
Eble
Michael
M
Flentje
Michael
M
Carstens
Detlef
D
Bottke
Dirk
D
Neumann
Patrick
P
Hinkelbein
Wolfgang
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008207:Lymphatic Metastasis / Q000473:pathology / Q000532:radiotherapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D010384:Pelvic Bones / Q000473:pathology; D010386:Pelvic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D014057:Tomography, X-Ray Computed