Prognostic factors in ambulatory patients with inoperable locoregionally recurrent rectal cancer following curative surgery
Pergolizzi, S.; Settineri, N.; Santacaterina, A.; Maisano, R.; Frosina, P.; Loria, F.; Nardella, G.; Garufi, G.; Sansotta, G.; De Renzis, C.
Anticancer Research 19(2b): 1383-1390
1999
ISSN/ISBN: 0250-7005 PMID: 10365110 Document Number: 511622
Background: The optimal treatment for locoregionally recurrent rectal cancer after curative surgery has not yet been defined. The definition of prognostic factors could lead to the selection of an aggressive therapeutic approach in patients with favourable prognosis alone. Patients and methods: The records of thirty-nine ambulatory pts, 15 female and 24 male, with diagnosis of locoregionally recurrent rectal cancer (LRRC) after curative surgery and treated with radiotherapy were retrospectively analyzed. The following factors were analyzed for their ability to predict the clinical response and outcome for LRRC: age, sex, initial tumor grading, primary surgical approach, initial primary tumor stage according to Dukes' classification, disease free survival (time to primary surgery and detection of a LRRC), pelvic-perineal structure affected by recurrence, total radiation dose, chemotherapy with fluorouracil, symptomatic response to the therapy, locoregional symptomatic re-recurrence, systemic progression disease. Results: In the univariate analysis, predictive factors for survival, were graded (G1-2 vs G3 p=0.04), Dukes' stage at first diagnosis (A-B vs C p=0.01), and site of pelvic-perineal recurrence (Pelvic mass alone yes vs no p=0.01; Nerve and/or Osseous involvement yes vs no p<0.001). Following therapy for LRRC, a better survival was observed in pts with a complete symptomatic response (complete remission vs partial remission vs no change p<0.001), without a further locoregional symptomatic re-recurrence (re-recurrence yes vs no p=0.001) and/or appearance of metastatic disease (yes vs no p<0.001). Multivariate analysis showed Dukes' stage (p=0.01, RR=0.5, CI 0.3-0.8), Grading (p=0.01, RR=0.5, CI 0.3-0.9), initial Surgical approach (p=0.02, RR=1.9, CI 1.1-3.3) and Pelvic mass alone (p=0.001, RR=0.4, CI 0.2-0.7) to be statistically significant. Conclusion: Good performance status, Grading 1-2, Dukes' stage A-B at first diagnosis of rectal cancer, initial conservative surgical approach and LRRC without pelvic nerve and/or osseous involvement indicate a favourable prognosis in LRRC. The results indicate the definition of a subgroup of patients for whom an aggressive therapeutic approach could be justified (external radiotherapy, surgery and intraoperative radiation therapy).