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Annals of Oncology Advance Access published online on November 4, 2009
Annals of Oncology, doi:10.1093/annonc/mdp501
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Results of European pooled analysis of IORT-containing multimodality treatment for locally advanced rectal cancer: adjuvant chemotherapy prevents local recurrence rather than distant metastases

M. Kusters1, V. Valentini2, F. A. Calvo3, R. Krempien4, G. A. Nieuwenhuijzen1, H. Martijn5, G. B. Doglietto6, E. del Valle7, F. Roeder4, M. W. Buchler8, C. J. H. van de Velde9 and H. J. T. Rutten1,*

1 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
2 Department of Radiation Oncology, Università Cattolica S. Cuore, Rome, Italy
3 Department of Oncology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
4 Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
5 Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
6 Department of Surgery, Università Cattolica S. Cuore, Rome, Italy
7 Department of General Surgery, Hospital Gregorio Marañón, Madrid, Spain
8 Department of Surgery, University of Heidelberg, Heidelberg, Germany
9 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

* Correspondence to: Dr H. J. Rutten, Department of Surgery, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands. Tel: +31-40-2397155; Fax: +31-40-2443370; E-mail: harm.rutten{at}cze.nl

Background: The purpose of this study is to analyze the pooled results of multimodality treatment of locally advanced rectal cancer (LARC) in four major treatment centers with particular expertise in intraoperative radiotherapy (IORT).

Patients and methods: A total of 605 patients with LARC who underwent multimodality treatment up to 2005 were studied. The basic treatment principle was preoperative (chemo)radiotherapy, intended radical surgery, IORT and elective adjuvant chemotherapy (aCT). In uni- and multivariate analyses, risk factors for local recurrence (LR), distant metastases (DM) and overall survival (OS) were studied.

Results: Chemoradiotherapy lead to more downstaging and complete remissions than radiotherapy alone (P < 0.001). In all, 42% of the patients received aCT, independent of tumor–node–metastasis stage or radicality of the resection. LR rate, DM rate and OS were 12.0%, 29.2% and 67.1%, respectively. Risk factors associated with LR were no downstaging, lymph node (LN) positivity, margin involvement and no postoperative chemotherapy. Male gender, preoperatively staged T4 disease, no downstaging, LN positivity and margin involvement were associated with a higher risk for DM. A risk model was created to determine a prognostic index for individual patients with LARC.

Conclusions: Overall oncological results after multimodality treatment of LARC are promising. Adding aCT to the treatment can possibly improve LR rates.

chemotherapy, intraoperative radiotherapy, locally advanced rectal carcinoma, multimodality treatment

Received for publication March 19, 2009. Revision received September 15, 2009. Accepted for publication September 17, 2009.


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