Neoadjuvant (re)chemoradiation for locally recurrent rectal cancer: Impact of anatomical site of pelvic recurrence on long-term results

Luca Sorrentino; Filiberto Belli; Francesca Valvo; Sergio Villa; Marcello Guaglio; Davide Scaramuzza; Alessandro Gronchi; Maria Di Bartolomeo; Maurizio Cosimelli

doi:10.1016/j.suronc.2020.08.017

Neoadjuvant (re)chemoradiation for locally recurrent rectal cancer: Impact of anatomical site of pelvic recurrence on long-term results

Surg Oncol. 2020 Dec:35:89-96. doi: 10.1016/j.suronc.2020.08.017. Epub 2020 Aug 20.

Authors

Luca Sorrentino¹, Filiberto Belli², Francesca Valvo³, Sergio Villa⁴, Marcello Guaglio¹, Davide Scaramuzza⁵, Alessandro Gronchi⁶, Maria Di Bartolomeo⁷, Maurizio Cosimelli¹

Affiliations

¹ Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
² Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. Electronic address: filiberto.belli@istitutotumori.mi.it.
³ Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.
⁴ Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
⁵ Department of Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
⁶ Sarcoma Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
⁷ Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.

PMID: 32858390
DOI: 10.1016/j.suronc.2020.08.017

Abstract

Background: Selection criteria to propose neoadjuvant (re)chemoradiation (CHRT) in locally recurrent rectal cancer (LRRC) are required, since re-irradiation is sometimes associated to severe adverse effects. Aim of the present study was to compare chances of R0 surgery and disease-free survival (DFS) in LRRC patients (pts) treated by neoadjuvant (re)CHRT followed by surgery vs. upfront surgery, stratifying pts by each localization of LRRC.

Methods: LRRC pts treated at the National Cancer Institute of Milan (Italy) were retrospectively divided into two groups: neoadjuvant (re)CHRT vs. upfront surgery. According to our Milan classification, LRRC were categorized as S1, if located centrally (S1a-b) or anteriorly (S1c) within the pelvis; S2, in case of sacral involvement; S3, in case of lateral pelvic wall infiltration.

Results: 152 pts were candidate for multimodal treatment: 49 (32.2%) by neoadjuvant (re)CHRT and surgery, including 33 re-irradiations, vs. 103 (67.8%) by upfront surgery. No difference was observed in R0 resection rates (respectively 47.6% vs. 51.0%). However, neoadjuvant (re)CHRT followed by surgery improved the DFS (p = 0.028), also in R1 procedures (p = 0.013), compared with upfront surgery. At multivariate analysis, the R+ surgery (p < 0.0001) strongly predicted unfavorable DFS, while neoadjuvant (re)CHRT followed by surgery was independently associated to better DFS (p = 0.0197). Stratifying by LRRC localization, the combined approach significantly improved DFS in the S1c (p = 0.029) and S2 (p = 0.004) subgroups compared to upfront surgery, but not in S1a-b and S3 pts.

Conclusion: Anterior (S1c) and sacral-invasive (S2) pelvic recurrences significantly benefit in terms of DFS by combination of neoadjuvant (re)CHRT and radical surgery, also after R1 resection.

Keywords: Locally recurrent rectal cancer; Neoadjuvant chemoradiation; Re-irradiation; Surgery.

MeSH terms

Chemoradiotherapy / mortality*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoadjuvant Therapy / mortality*
Neoplasm Recurrence, Local / mortality*
Neoplasm Recurrence, Local / pathology
Neoplasm Recurrence, Local / therapy
Pelvic Neoplasms / mortality*
Pelvic Neoplasms / secondary
Pelvic Neoplasms / therapy
Prognosis
Rectal Neoplasms / mortality*
Rectal Neoplasms / pathology
Rectal Neoplasms / therapy
Retrospective Studies
Survival Rate