title: Single-Institution Multidisciplinary Management of Locoregional Oligo-Recurrent Pelvic Malignancies: Long-Term Outcome Analysis.
abstract: OBJECTIVE
  The aim of this study was to analyze long-term outcomes and prognostic factors associated with survival in patients with locoregional oligo-recurrent (LROR) pelvic malignancies treated in a multimodal protocol.
  
  
  METHODS
  Patients with an histologic diagnosis of LROR pelvic cancer (rectal 50 %, gynecological 50 %) with absence of distant metastases, undergoing surgery with radical intent and intraoperative radiotherapy (median dose 12.5 Gy) were considered eligible for participation in this study. Additionally, 48 % received external beam radiotherapy (EBRT) (median dose 50 Gy).
  
  
  RESULTS
  From 1995 to 2012, a total of 143 patients from a single institution were analyzed. With a median follow-up time of 48 months (range 2-189), 5-year locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) were 53, 44, and 46 %, respectively. On multivariate analysis, no EBRT treatment to the locoregional (p ≤ 0.001), R1 margin status (p = 0.03), time interval from primary tumor diagnosis to LROR <24 months (p = 0.05), and fragmentation in the resected specimen (p = 0.004) retained significance in relation to LRC. On multivariate analysis we found that only R1 margin status (p = 0.003), primary tumor diagnosis to LROR <24 months (p = 0.02), and high histological grade (p = 0.02) were significantly associated with OS.
  
  
  CONCLUSIONS
  From this analysis emerges the fact that EBRT influences local control but, given the high risk of distant metastases, DFS remains modest. Margin status, tumor fragmentation, no EBRT to the LR, and time interval from primary tumor diagnosis to LROR are the dominant factors for subsequent locoregional recurrence (LRR). Accordingly, future prospective studies might be designed which adapt treatment according to the predicted risk of subsequent LRR.
authors.affiliation: Service of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile. csole@iram.cl.|Health Research Institute, Hospital Gregorio Marañón, Madrid, Spain. csole@iram.cl.
authors.forename: Claudio V
authors.initials: CV
authors.lastname: Sole
authors.affiliation: Health Research Institute, Hospital Gregorio Marañón, Madrid, Spain.|Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|School of Medicine, Complutense University, Madrid, Spain.
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Calvo
authors.affiliation: Health Research Institute, Hospital Gregorio Marañón, Madrid, Spain.|School of Medicine, Complutense University, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Lizarraga
authors.affiliation: Health Research Institute, Hospital Gregorio Marañón, Madrid, Spain.|School of Medicine, Complutense University, Madrid, Spain.|Service of General Surgery III, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Gonzalez-Bayon
authors.affiliation: Health Research Institute, Hospital Gregorio Marañón, Madrid, Spain.|School of Medicine, Complutense University, Madrid, Spain.|Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Carmen Gonzalez San
authors.initials: CG
authors.lastname: Segundo
authors.affiliation: Health Research Institute, Hospital Gregorio Marañón, Madrid, Spain.|Department of Experimental Surgery and Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Desco
authors.affiliation: Health Research Institute, Hospital Gregorio Marañón, Madrid, Spain.|School of Medicine, Complutense University, Madrid, Spain.|Service of General Surgery III, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: García-Sabrido
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate