title: Preoperative radiotherapy improves outcome in recurrent rectal cancer.
abstract: OBJECTIVE
  When local recurrent rectal cancer is diagnosed without signs of metastases, a potentially curative resection can be performed. This study was designed to compare the results of preoperative radiotherapy followed by surgery with surgery only.
  
  
  METHODS
  Between 1985 and 2003, 117 patients with recurrent rectal cancer were prospectively entered in our database. Ninety-two patients were suitable for resection with curative intent. Preoperative radiation with a median dosage of 50 Gy was performed in 59 patients; 33 patients did not receive preoperative radiotherapy. The median age of the patients was respectively 66 and 62 years.
  
  
  RESULTS
  The median follow-up of patients alive for the total group was 16 (range, 4-156) months. Tumor characteristics were comparable between the two groups. Complete resections were performed in 64 percent of the patients who received preoperative radiation and 45 percent of the nonirradiated patients. A complete response after radiotherapy was found in 10 percent of the preoperative irradiated patients (n = 6). There were no differences in morbidity and reintervention rate between the two groups. Local control after preoperative radiotherapy was statistically significantly higher after three and five years (P = 0.036). Overall survival and metastases-free survival were not different in both groups. Complete response to preoperative radiotherapy was predictive for an improved survival.
  
  
  CONCLUSIONS
  Preoperative radiotherapy for recurrent rectal cancer results in a higher number of complete resections and an improved local control compared with patients treated without radiotherapy. Preoperative radiotherapy should be standard treatment for patients with recurrent rectal cancer.
authors.affiliation: Department of Surgical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, 3008 Rotterdam, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Vermaas
authors.forename: Floris T J
authors.initials: FT
authors.lastname: Ferenschild
authors.forename: Joost J M E
authors.initials: JJ
authors.lastname: Nuyttens
authors.forename: Andreas W K S
authors.initials: AW
authors.lastname: Marinelli
authors.forename: Theo
authors.initials: T
authors.lastname: Wiggers
authors.forename: Joost R M M
authors.initials: JR
authors.lastname: van der Sijp
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.forename: Wilfried J
authors.initials: WJ
authors.lastname: Graveland
authors.forename: Alexander M M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011300:Preoperative Care; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome