title: Preoperative irradiation and surgery for local recurrence of rectal and rectosigmoid cancer. Prognostic factors with regard to survival and further local recurrence.
abstract: OBJECTIVE
  Local recurrence after rectal cancer surgery is an important clinical problem.
  
  
  METHODS
  150 patients with local recurrence after rectal/rectosigmoid cancer, stage M0, underwent surgery after preoperative irradiation (46-50 Gy).
  
  
  RESULTS
  The overall 5-year survival was 27% (44% R0, 38% R1 and 17% R2-stage). Corresponding survival/local recurrence rates were 52%/27% for R0- and 14%/63% for R1-stage. No R2-resected survived 4 years. A normal pretreatment CEA level was significantly associated with increased survival but normalization following preoperative therapy was not associated with an improvement in prognosis. Survival and local recurrence were also significantly influenced by the type of primary operation. Several factors were significant for the prediction of an R0-resection in univariate analysis, but only CEA and symptoms at the time of recurrence predicted an R0-resection in multivariate analysis. A long latency time to recurrence did not significantly influence prognosis.
  
  
  CONCLUSIONS
  Preoperative irradiation and surgery can result in an R0-resection and a long survival in patients with recurrence after initial treatment for rectal or rectosigmoid cancer. Also patients with an R1-resection can benefit from surgery since a substantial number will die without further local recurrence. An R0-resection is the main prognostic factor followed by CEA level, sex and type of primary operation. Normalization of CEA after preoperative treatment is not of prognostic significance. The value of the Norwegian follow-up regimen is questioned.
authors.affiliation: Department of Operative treatment, The Norwegian Radium Hospital, Oslo, Norway. johan.wiig@radiumhospitalet.no
authors.forename: J N
authors.initials: JN
authors.lastname: Wiig
authors.forename: S G
authors.initials: SG
authors.lastname: Larsen
authors.forename: S
authors.initials: S
authors.lastname: Dueland
authors.forename: K-E
authors.initials: KE
authors.lastname: Giercksky
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D003082:Colectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy; D012811:Sigmoid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome