The role of postoperative pelvic radiation in stage IV rectal cancer after resection of primary tumor.
OBJECTIVE
To evaluate the effect of pelvic radiotherapy (RT) in patients with stage IV rectal cancer treated with resection of primary tumor with or without metastasectomy.


METHODS
Medical records of 112 patients with stage IV rectal cancer treated with resection of primary tumor between 1990 and 2011 were retrospectively reviewed. Fifty-nine patients received synchronous or staged metastasectomy whereas fifty-three patients did not. Twenty-six patients received pelvic radiotherapy.


RESULTS
Median overall survival (OS), locoregional recurrence-free survival (LRFS), and progression-free survival (PFS) of all patients was 27, 70, and 11 months, respectively. Pathologic T (pT), N (pN) classification and complete metastasectomy were statistically significant factors in OS (p = 0.040, 0.020, and 0.002, respectively). RT did not improve OS or LRFS. There were no significant factors in LRFS. pT and pN classification were also significant prognostic factors in PFS (p = 0.010 and p = 0.033, respectively). In the subgroup analysis, RT improved LRFS in patients with pT4 disease (p = 0.026). The locoregional failure rate of the RT group and the non-RT group were 23.1% and 33.7%, showing no difference in the failure pattern of both groups (p = 0.260).


CONCLUSIONS
Postoperative pelvic RT did not improve LRFS of all metastatic rectal cancer patients; however, it can be recommended to patients with pT4 disease. A complete resection of metastatic masses should be performed if possible.
Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
Joo Hwan
JH
Lee
In Young
IY
Jo
Jong Hoon
JH
Lee
Sei Chul
SC
Yoon
Yeon-Sil
YS
Kim
Byung Ock
BO
Choi
Jun-Gi
JG
Kim
Seong Taek
ST
Oh
Myeong A
MA
Lee
Hong-Seok
HS
Jang
Local neoplasm recurrence; Neoplasm metastasis; Radiotherapy; Rectal neoplasms