title: Patterns of local recurrence in locally advanced rectal cancer after intra-operative radiotherapy containing multimodality treatment.
abstract: OBJECTIVE
  The purpose of this study is to analyze the patterns of local recurrence (LR) after intra-operative radiotherapy (IORT) containing multimodality treatment of locally advanced rectal carcinoma (LARC).
  
  
  METHODS
  Two hundred and ninety patients with LARC who underwent multimodality treatment between 1994 and 2006 were studied. For patients who developed LR, the subsite was classified into presacral, postero-lateral, lateral, anterior, anastomotic or perineal. Patient and treatment characteristics were related to subsite of LR.
  
  
  RESULTS
  After 5years, 34 patients (13.2%) developed LR. The most prominent subsite of LR was the presacral subsite. 47% of the local recurrences occurred outside the IORT field. Most recurrences developed when IORT was given dorsally, while least occurred when IORT was given ventrally. Especially after dorsal IORT a high amount of infield recurrences were observed (6 of 8; 75%). In multi-variate analysis tumor distance of more than 5cm from the anal verge and a positive circumferential margin were associated with presacral local recurrence.
  
  
  CONCLUSIONS
  Multimodality treatment is effective in the prevention of local recurrence in LARC. IORT application to the area most at risk is feasible and seems effective in the prevention of local recurrence. Dorsal tumor location results in unfavourable oncologic results.
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Miranda
authors.initials: M
authors.lastname: Kusters
authors.forename: Fabian A
authors.initials: FA
authors.lastname: Holman
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: Hetty A
authors.initials: HA
authors.lastname: van den Berg
authors.forename: Adriaan J
authors.initials: AJ
authors.lastname: van den Brule
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: Harm J T
authors.initials: HJ
authors.lastname: Rutten