title: Post-chemoradiation intraoperative electron-beam radiation therapy boost in resected locally advanced rectal cancer: long-term results focused on topographic pattern of locoregional relapse.
abstract: BACKGROUND
  Patients with locally advanced rectal cancer (LARC) have a dismal prognosis. We investigated outcomes and risk factors for locoregional recurrence (LRR) in patients treated with preoperative chemoradiotherapy (CRT), surgery and IOERT.
  
  
  METHODS
  A total of 335 patients with LARC [⩾cT3 93% and/or cN+ 69%) were studied. In multivariate analyses, risk factors for LRR, IFLR and OFLR were assessed.
  
  
  RESULTS
  Median follow-up was 72.6 months (range, 4-205). In multivariate analysis distal margin distance ⩽10 mm [HR 2.46, p = 0.03], R1 resection [HR 5.06, p = 0.02], tumor regression grade 1-2 [HR 2.63, p = 0.05] and tumor grade 3 [HR 7.79, p < 0.001] were associated with an increased risk of LRR. A risk model was generated to determine a prognostic index for individual patients with LARC.
  
  
  CONCLUSIONS
  Overall results after multimodality treatment of LARC are promising. Classification of risk factors for LRR has contributed to propose a prognostic index that could allow us to guide risk-adapted tailored treatment.
authors.affiliation: Department of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: cvsole@uc.cl.
authors.forename: Claudio V
authors.initials: CV
authors.lastname: Sole
authors.affiliation: Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Calvo
authors.affiliation: School of Medicine, Complutense University, Madrid, Spain; Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Serrano
authors.affiliation: Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Del Valle
authors.affiliation: Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Marcos
authors.initials: M
authors.lastname: Rodriguez
authors.affiliation: School of Medicine, Complutense University, Madrid, Spain; Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Muñoz-Calero
authors.affiliation: Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Turégano
authors.affiliation: School of Medicine, Complutense University, Madrid, Spain; Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: García-Sabrido
authors.affiliation: School of Medicine, Complutense University, Madrid, Spain; Service of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Garcia-Alfonso
authors.affiliation: Department of Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Peligros
authors.affiliation: Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France; Molecular Radiotherapy Laboratory INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; School of Medicine, Paris-Sud University, Villejuif, France.
authors.forename: Sofia
authors.initials: S
authors.lastname: Rivera
authors.affiliation: Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France; Molecular Radiotherapy Laboratory INSERM1030, Gustave Roussy Cancer Campus, Villejuif, France; School of Medicine, Paris-Sud University, Villejuif, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Deutsch
authors.affiliation: School of Medicine, Complutense University, Madrid, Spain; Department of Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigacion Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Alvarez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000379:methods; D004583:Electrons; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007430:Intraoperative Care; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D011379:Prognosis; D020266:Radiotherapy, Conformal / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D005641:Tegafur / Q000008:administration & dosage
chemical_list: D009944:Organoplatinum Compounds; D005641:Tegafur; D002955:Leucovorin; D005472:Fluorouracil
keywords: External beam radiation therapy; Intraoperative radiotherapy; Locally advanced rectal cancer; Surgery