title: Radical resection after IORT-containing multimodality treatment is the most important determinant for outcome in patients treated for locally recurrent rectal cancer.
abstract: BACKGROUND
  The optimal treatment for locally recurrent rectal cancer (LRRC) is still a matter of debate. This study assessed the outcome of LRRC patients treated with multimodality treatment, consisting of neoadjuvant radio (chemo-) therapy, extended resection, and intraoperative radiotherapy.
  
  
  METHODS
  One hundred and forty-seven consecutive patients with LRRC who underwent treatment between 1994 and 2006 were studied. The prognostic values of patient-, tumor- and treatment-related characteristics were tested with uni- and multivariate analysis.
  
  
  RESULTS
  Median overall survival was 28 months (range 0-146 months). Five-year overall, disease-free, and metastasis-free survival and local control (OS, DFS, MFS, and LC respectively) were 31.5%, 34.1%, 49.5% and 54.1% respectively. Radical resection (R0) was obtained in 84 patients (57.2%), microscopically irradical resection (R1) in 34 patients (23.1%), and macroscopically irradical resection (R2) in 29 patients (19.7%). For patients with a radical resection median OS was 59 months and the 5-year OS, DFS, MFS, and LC were 48.4%, 52.3%, 65.5% and 68.9%, respectively. Radical resection was significantly correlated with improved OS, DFS, and LC (P < 0.001). Patients who received re-irradiation or full-course radiotherapy survived significantly longer (P = 0.043) and longer without local recurrence (P = 0.038) or metastasis (P < 0.001) compared to patients who were not re-irradiated.
  
  
  CONCLUSIONS
  Radical resection is the most significant predictor of improved survival in patients with LRRC. Neoadjuvant radio (chemo-) therapy is the best option in order to realize a radical resection. Re-irradiation is feasible in patients who already received irradiation as part of the primary rectal cancer treatment.
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, Postbox 1350, 5602 ZA, Eindhoven, The Netherlands.
authors.forename: Raphaëla C
authors.initials: RC
authors.lastname: Dresen
authors.forename: Marleen J
authors.initials: MJ
authors.lastname: Gosens
authors.forename: Hendrik
authors.initials: H
authors.lastname: Martijn
authors.forename: Grard A
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Creemers
authors.forename: Alette W
authors.initials: AW
authors.lastname: Daniels-Gooszen
authors.forename: Adriaan J
authors.initials: AJ
authors.lastname: van den Brule
authors.forename: Hetty A
authors.initials: HA
authors.lastname: van den Berg
authors.forename: Harm J
authors.initials: HJ
authors.lastname: Rutten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery / Q000628:therapy*; D011878:Radiotherapy; D012004:Rectal Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome