title: Patterns of failure in patients with early onset (synchronous) resectable liver metastases from rectal cancer.
abstract: BACKGROUND
  The optimal combination of available therapies for patients with resectable synchronous liver metastases from rectal cancer (SLMRC) is unknown, and the pattern of recurrence after resection has been poorly investigated. In this study, the authors examined recurrence patterns and survival after resection of SLMRC.
  
  
  METHODS
  Consecutive patients with SLMRC (disease-free interval, ≤12 months) who underwent complete resection of the rectal primary and liver metastases between 1990 and 2008 were identified from a prospective database. Demographics, tumor-related variables, and treatment-related variables were correlated with recurrence patterns. Competing risk analysis was used to determine the risk of pelvic and extrapelvic recurrence.
  
  
  RESULTS
  In total, 185 patients underwent complete resection of rectal primary and liver metastases. One hundred eighty patients (97%) received chemotherapy during their treatment course, and 91 patients (49%) received pelvic radiation therapy either before (N = 65; 71.4%), or after (N = 26; 28.6%) rectal resection. The 5-year disease-specific survival rate was 51% for the entire cohort with a median follow-up of 44 months for survivors. One hundred thirty patients (70%) developed a recurrence: Eighteen patients (10%) had recurrences in the pelvis in combination with other sites, and 7 of these (4%) had an isolated pelvic recurrence. Recurrence pattern did not correlate with survival. Competing risk analysis demonstrated that the likelihood of a pelvic recurrence was significantly lower than that of an extrapelvic recurrence (P < .001).
  
  
  CONCLUSIONS
  Of the patients with SLMRC who developed recurrent disease, systemic sites were overwhelmingly more common than pelvic recurrences. The current results indicated that the selective exclusion of radiotherapy may be considered in patients who are diagnosed with simultaneous disease.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Butte
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Peirong
authors.initials: P
authors.lastname: Ding
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Nash
authors.forename: Jose
authors.initials: J
authors.lastname: Guillem
authors.forename: Philip B
authors.initials: PB
authors.lastname: Paty
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Saltz
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Kemeny
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Dematteo
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: Martin R
authors.initials: MR
authors.lastname: Weiser
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D018570:Risk Assessment; D055815:Young Adult