title: Outcome in patients with resectable locally recurrent rectal cancer after total mesorectal excision with and without previous neoadjuvant radiotherapy for the primary rectal tumor.
abstract: BACKGROUND
  The widespread use of neoadjuvant radiotherapy (nRTx) followed by total mesorectal excision (TME) introduced the problem of treating locally recurrent rectal cancer (LRRC) after nRTx and TME. Few data exist on the outcome of the surgical treatment of this type of LRRC and the influence of nRTx for the primary tumor on the outcome is unclear.
  
  
  METHODS
  All patients receiving multimodality treatment (including intraoperative radiotherapy) for LRRC in our center between 1996 and 2012 were analyzed retrospectively. The outcome of patients with nonmetastasized resectable LRRC who received nRTx and TME for the primary tumor was compared to the outcome of patients who did not receive nRTx for the primary tumor.
  
  
  RESULTS
  During this period, 139 patients underwent surgery for LRRC; 93 of these patients underwent curative surgery for LRRC after TME for the primary tumor. Sixty-five patients did not receive nRTx for the primary tumor, whereas 28 patients received nRTx for the primary tumor. There were no significant differences in the number of incomplete resections or perioperative morbidities. There was no significant difference in 5-year overall survival (28 vs. 43%, p = 0.81), recurrence-free survival (55 vs. 48%, p = 0.5), and disease-free survival (27 vs. 40%, p = 0.59).
  
  
  CONCLUSIONS
  Surgical treatment of carefully selected patients with nonmetastasized resectable LRRC after nRTx and TME for the primary tumor is feasible and can result in sustained local control and overall survival. Patients with resectable LRRC who received nRTx for the primary tumor do not have a poorer outcome than patients who did not.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Wijnand J
authors.initials: WJ
authors.lastname: Alberda
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.forename: Joost J
authors.initials: JJ
authors.lastname: Nuyttens
authors.forename: Joost
authors.initials: J
authors.lastname: Rothbarth
authors.forename: Esther
authors.initials: E
authors.lastname: van Meerten
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
authors.forename: Jacobus W A
authors.initials: JW
authors.lastname: Burger
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D000368:Aged; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D015996:Survival Rate; D062606:Tertiary Care Centers