Results of European pooled analysis of IORT-containing multimodality treatment for locally advanced rectal cancer: adjuvant chemotherapy prevents local recurrence rather than distant metastases.
BACKGROUND
The purpose of this study is to analyze the pooled results of multimodality treatment of locally advanced rectal cancer (LARC) in four major treatment centers with particular expertise in intraoperative radiotherapy (IORT).


METHODS
A total of 605 patients with LARC who underwent multimodality treatment up to 2005 were studied. The basic treatment principle was preoperative (chemo)radiotherapy, intended radical surgery, IORT and elective adjuvant chemotherapy (aCT). In uni- and multivariate analyses, risk factors for local recurrence (LR), distant metastases (DM) and overall survival (OS) were studied.


RESULTS
Chemoradiotherapy lead to more downstaging and complete remissions than radiotherapy alone (P < 0.001). In all, 42% of the patients received aCT, independent of tumor-node-metastasis stage or radicality of the resection. LR rate, DM rate and OS were 12.0%, 29.2% and 67.1%, respectively. Risk factors associated with LR were no downstaging, lymph node (LN) positivity, margin involvement and no postoperative chemotherapy. Male gender, preoperatively staged T4 disease, no downstaging, LN positivity and margin involvement were associated with a higher risk for DM. A risk model was created to determine a prognostic index for individual patients with LARC.


CONCLUSIONS
Overall oncological results after multimodality treatment of LARC are promising. Adding aCT to the treatment can possibly improve LR rates.
Kusters
M
M
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Valentini
V
V
Department of Radiation Oncology, Università Cattolica S. Cuore, Rome, Italy.
Calvo
F A
FA
Department of Oncology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Krempien
R
R
Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
Nieuwenhuijzen
G A
GA
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Martijn
H
H
Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands.
Doglietto
G B
GB
Department of Surgery, Università Cattolica S. Cuore, Rome, Italy.
Del Valle
E
E
Department of General Surgery, Hospital Gregorio Marañón, Madrid, Spain.
Roeder
F
F
Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
Buchler
M W
MW
Department of Surgery, University of Heidelberg, Heidelberg, Germany.
van de Velde
C J H
CJH
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Rutten
H J T
HJT
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: harm.rutten@cze.nl.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods*; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis