Multidisciplinary therapy for patients with locally oligo-recurrent pelvic malignancies.
OBJECTIVE
To analyze prognostic factors and long-term outcomes in patients with locally recurrent pelvic cancer (LRPC) treated with a multidisciplinary approach.


METHODS
From January 1995 to December 2011, 81 patients [rectal (47 %); gynecologic (39 %); retroperitoneal sarcoma (14 %)] underwent extended surgery [multiorgan (58 %), bone (35 %), vascular (9 %), soft tissue (63 %)] and intraoperative electron beam radiation therapy (IOERT) to treat recurrent tumors in the pelvic region. Thirty-five patients (43 %) received external beam radiotherapy (EBRT). Survival was estimated using the Kaplan-Meier method, and risk factors were identified using univariate and multivariate analysis.


RESULTS
Median follow-up was 39 months (6-189 months); the 1- 3- and 5-year rates of locoregional control (LRC) were 83, 53, and 41 %, respectively. Univariate Cox proportional hazard analysis revealed worse LRC in patients who did not receive integrated EBRT as rescue treatment of pelvic recurrence (p = 0.003) or underwent non-radical resection (p = 0.01). In the multivariate analysis EBRT, non-radical resection, and tumor fragmentation retained significance (p = 0.002, p = 0.004, and p = 0.05, respectively).


CONCLUSIONS
Radical resection, absence of tumor fragmentation and addition of EBRT for rescue are associated with improved LRC in patients with LRPC. Our results suggest that this group can benefit from EBRT combined with extended surgical resection and IOERT.
Service of Radiation Oncology, Instituto de Radiomedicina, Ave. Americo Vespucio Norte, 1314, 7630370, Santiago, Chile, cvsole@uc.cl.
Claudio V
CV
Sole
Felipe A
FA
Calvo
Pedro Alvarez
PA
de Sierra
Rafael
R
Herranz
Luis
L
Gonzalez-Bayon
Jose Luis
JL
García-Sabrido
D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D033183:Interdisciplinary Communication; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000628:therapy*; D010348:Patient Care Team; D010386:Pelvic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome; D055815:Young Adult