Salvage Treatment for Locally Recurrent Rectal Cancer

Noh, Jae Myoung; Park, Won; Ahn, Yong Chan; Yoon, Sang Min; Huh, Seung Jae; Lim, Do Hoon; Chun, Ho Kyung; Lee, Woo Yong; Yun, Seong Hyeon; Kang, Won Ki; Park, Young Suk; Park, Joon Oh

Abstract

PURPOSE: To evaluate the treatment outcome according to the salvage treatment modalities and identify the prognostic factors influencing the survival.
MATERIALS AND METHODS
Forty-five patients with locally recurrent rectal cancer treated between 1994 to 2003 were reviewed retrospectively. Median time from initial surgery to local recurrence was 16months. Of the patients, 25 (56%) recurred at presacral and perirectal space. Among the 18 (40%) patients who received salvage surgery, 14 patients were treated with postoperative chemoradiotherapy. Among 27 (60%) patients who didn't receive salvage surgery, 16 were treated with chemoradiotherapy and 11 were treated with radiotherapy alone. Radiotherapy was given with total dose ranging from 37.5 to 64.8 Gy.
RESULTS
Five-year locoregional progression-free survival rate and overall survival rate of all patients were 49.5% and 34.3%, respectively. The 5-year locoregional progression-free survival rate and overall survival rate of patients undergoing salvage surgery were 77.0% and 52.1% compared with 36.0% and 37.9% for patients treated with chemoradiotherapy and 0% and 0% for patients treated with radiotherapy alone, respectively. The 5-year locoregional progression free survival and overall survival of patients who recurred earlier than 24 months were higher (67.5% and 59.1%) than the other patients (39.5% and 24.9%). Among the 27 patients who didn't receive salvage surgery, there was no significant difference for locoregional progression free survival and overall survival between re-irradiated patients and radiation-naive patients.
CONCLUSION
Surgical resection is preferred to treatment for locally recurrent rectal cancer. If salvage surgery is not possible, chemoradiotherapy may achieve higher locoregional progression free survival and overall survival than radiotherapy alone.