Prognostic factors after preoperative irradiation and surgery for locally advanced rectal cancer

• Published in: European journal of surgical oncology Vol. 34; no. 4; pp. 410 - 417
• Main Authors: Larsen, S.G, Wiig, J.N, Dueland, S, Giercksky, K.-E
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-04-2008
• Subjects: Adult; Aged; Aged, 80 and over; Colectomy; Female; Hematology, Oncology and Palliative Medicine; Humans; Locally advanced; Male; Middle Aged; Multimodality treatment; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Prognostic factors; Radiotherapy; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Rectal tumour; Surgery; Survival Analysis; Rectal tumour; Multimodality treatment; Radiotherapy; Surgery; Locally advanced; Prognostic factors
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2007.05.012

Abstract Aims The experience of preoperative irradiation in clinically locally advanced rectal cancer for the period 1991–2003 is reported. Prognostic factors for survival and recurrence, and parameters for obtaining a free circumferential margin were evaluated. Methods A prospective cohort study of 204 M0 patients given >45 Gy preoperatively (median age 66 years; 29% women; tumour level <16 cm from the anal verge). Results Multivisceral and/or pelvic wall resections were performed in 61% of the patients. R0, R1 and R2 resections were achieved in 74%, 21% and 5%. Five-year survival was 52% for all patients, 60% for R0 resections, 31% for R1 and 0% for R2. The calculated 5-year recurrence rates were 13% for R0 resections and 24% for R1 resections ( p < 0.035). R-stage, N-stage, age, type of rectal resection and pelvic wall resection remained significant in Cox multivariate analysis for survival. Regarding local recurrence, the following parameters were independent: N-stage, carcinoembryonic antigen (CEA) response and pelvic wall resection. Medium high tumour level and reduced histopathological differentiation are important individual factors that seem to predict increased risk for not obtaining a R0 resection. Conclusions After preoperative irradiation and surgery, about 50% of the patients with locally advanced rectal cancer without overt metastases (M0) can be cured.