title: Prognostic impact of external beam radiation therapy in patients treated with and without extended surgery and intraoperative electrons for locally recurrent rectal cancer: 16-year experience in a single institution.
abstract: OBJECTIVE
  To analyze prognostic factors associated with survival in patients after intraoperative electrons containing resective surgical rescue of locally recurrent rectal cancer (LRRC).
  
  
  METHODS
  From January 1995 to December 2011, 60 patients with LRRC underwent extended surgery (n=38: multiorgan [43%], bone [28%], soft tissue [38%]) or nonextended (n=22) surgical resection, including a component of intraoperative electron-beam radiation therapy (IOERT) to the pelvic recurrence tumor bed. Twenty-eight (47%) of these patients also received external beam radiation therapy (EBRT) (range, 30.6-50.4 Gy). Survival outcomes were estimated by the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses.
  
  
  RESULTS
  The median follow-up time was 36 months (range, 2-189 months), and the 1-year, 3-year, and 5-year rates for locoregional control (LRC) and overall survival (OS) were 86%, 52%, and 44%; and 78%, 53%, 43%, respectively. On multivariate analysis, R1 resection, EBRT at the time of pelvic rerecurrence, no tumor fragmentation, and non-lymph node metastasis retained significance with regard to LRR. R1 resection and no tumor fragmentation showed a significant association with OS after adjustment for other covariates.
  
  
  CONCLUSIONS
  EBRT treatment integrated for rescue, resection radicality, and not involved fragmented resection specimens are associated with improved LRC in patients with locally recurrent rectal cancer. Additionally, tumor fragmentation could be compensated by EBRT. Present results suggest that a significant group of patients with LRRC may benefit from EBRT treatment integrated with extended surgery and IOERT.
authors.affiliation: Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Calvo
authors.forename: Claudio V
authors.initials: CV
authors.lastname: Sole
authors.forename: Pedro
authors.initials: P
authors.lastname: Alvarez de Sierra
authors.forename: Marina
authors.initials: M
authors.lastname: Gómez-Espí
authors.forename: Jose
authors.initials: J
authors.lastname: Blanco
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Lozano
authors.forename: Emilio
authors.initials: E
authors.lastname: Del Valle
authors.forename: Marcos
authors.initials: M
authors.lastname: Rodriguez
authors.forename: Alberto
authors.initials: A
authors.lastname: Muñoz-Calero
authors.forename: Fernando
authors.initials: F
authors.lastname: Turégano
authors.forename: Rafael
authors.initials: R
authors.lastname: Herranz
authors.forename: Luis
authors.initials: L
authors.lastname: Gonzalez-Bayon
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: García-Sabrido
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use; D004583:Electrons / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents