The role of adjuvant pelvic radiotherapy in rectal cancer with synchronous liver metastasis: a retrospective study.
BACKGROUND
Synchronous liver metastases are detected in approximately 25% of colorectal cancer patients at diagnosis. The rates of local failure and distant metastasis are substantial in these patients, even after undergoing aggressive treatments including resection of primary and metastatic liver tumors. The purpose of this study was to determine whether adjuvant pelvic radiotherapy is beneficial for pelvic control and overall survival in rectal cancer patients with synchronous liver metastasis after primary tumor resection.


METHODS
Among rectal cancer patients who received total mesorectal excision (TME) between 1997 and 2006 at Yonsei University Health System, eighty-nine patients diagnosed with synchronous liver metastasis were reviewed. Twenty-seven patients received adjuvant pelvic RT (group S + R), and sixty-two patients were managed without RT (group S). Thirty-six patients (58%) in group S and twenty patients (74%) in group S+R received local treatment for liver metastasis. Failure patterns and survival outcomes were analyzed.


RESULTS
Pelvic failure was observed in twenty-five patients; twenty-one patients in group S (34%), and four patients in group S+R (15%) (p = 0.066). The two-year pelvic failure-free survival rates (PFFS) of group S and group S+R were 64.8% and 80.8% (p = 0.028), respectively, and the two-year overall survival rates (OS) were 49.1% and 70.4% (p = 0.116), respectively. In a subgroup analysis of fifty-six patients who received local treatment for liver metastasis, the two-year PFFS were 64.9% and 82.9% (p = 0.05), respectively; the two-year OS were 74.1% and 80.0% (p = 0.616) in group S (n = 36) and group S+R (n = 20), respectively.


CONCLUSIONS
Adjuvant pelvic RT significantly reduced the pelvic failure rate but its influence on overall survival was unclear. Rectal cancer patients with synchronous liver metastasis may benefit from adjuvant pelvic RT through an increased pelvic control rate and improved quality of life.
Kim
Jun Won
JW
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, 134 Sinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
Kim
Yong Bae
YB
Kim
Nam-Kyu
NK
Min
Byung-Soh
BS
Shin
Sang Joon
SJ
Ahn
Joong Bae
JB
Koom
Woong Sub
WS
Seong
Jinsil
J
Keum
Ki Chang
KC
D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Prog Clin Cancer. 1978;7:217-33
360278
Dis Colon Rectum. 1999 May;42(5):632-9
10344686
J Clin Oncol. 1991 Jul;9(7):1105-12
2045852
Cancer Metastasis Rev. 1984;3(4):303-24
6394125
Semin Oncol. 1991 Oct;18(5):411-20
1925630
Br J Surg. 1988 Jul;75(7):641-4
3416116
World J Surg. 1987 Aug;11(4):541-7
3630198
Swiss Surg. 1996;Suppl 4:4-17
8963836
Arch Surg. 1984 Jun;119(6):647-51
6732473
J Prev Med Public Health. 2008 Mar;41(2):84-91
18385548
Semin Oncol. 1991 Aug;18(4):399-406
1650502
Lancet. 1994 Jun 4;343(8910):1405-10
7515134
Int J Radiat Oncol Biol Phys. 2001 Jan 1;49(1):107-16
11163503
Am J Surg. 1978 Jan;135(1):81-5
623377
Radiother Oncol. 1988 Dec;13(4):245-52
3064191
Surg Gynecol Obstet. 1970 Oct;131(4):697-700
5458530
Dis Colon Rectum. 1988 Jan;31(1):1-4
3366020
Ann Surg. 1987 Mar;205(3):264-70
3827362