| Multimodality salvage of recurrent disease after local excision for rectal cancer. | |
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MedLine Citation:
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PMID: 23135578 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Local excision, alone or in combination with chemoradiation, is increasingly considered for rectal cancer. Higher risks of disease recurrence have been demonstrated after local excision. OBJECTIVE: The aim of this study was to examine the outcomes of current-era multimodality salvage for recurrent rectal cancer after local excision. DESIGN: This was a single-institutional retrospective study. SETTINGS: This study was conducted at a tertiary-referral cancer center between 1993 and 2011. PATIENTS: Forty-six patients with recurrent rectal cancer after initial local excision were included. INTERVENTION: Multimodality salvage treatment was performed as appropriate. MAIN OUTCOME MEASURES: The primary outcomes measured were the pattern of disease recurrence, salvage treatments, and resultant overall and re-recurrence-free survival. RESULTS: After the initial local excision, recurrent disease was diagnosed after a median interval of 1.9 years: local/regionally in 67%, distantly in 18%, and both in 15%. Four patients (9%) had recurrence that was unsalvageable, 2 (4%) declined treatment, and 40 (87%) underwent surgical salvage. Preoperative chemoradiation was given in 30 (75%) patients. The R0 resection rate was 80%, requiring multivisceral resection (33%), total pelvic exenteration (5%), and metastasectomy (25%). The rate of sphincter preservation was 33%, and perioperative morbidity was 50%. The first site of failure after salvage was distant in 38% and was local only in 10%. The 5-year overall and 3-year re-recurrence-free survival were 63% and 43%. Pathologic stage at initial local excision, receipt of neoadjuvant chemoradiation before local excision, recurrence pattern after local excision, pathologic stage at salvage, and R0 resection at salvage influenced re-recurrence-free survival. LIMITATIONS: This study was limited by the referral and selection biases inherent in a small study cohort. CONCLUSIONS: Failure after local excision for rectal cancer may not be salvageable. When feasible, multimodality treatment, including multivisceral resection, pelvic irradiation, and chemotherapy, was associated with potentially lasting treatment-related morbidities and only modest success in long-term disease control. These findings should be compared with the expected stage-specific outcomes of standard proctectomy for early-stage rectal cancer, when local excision is being considered. |
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Authors:
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Y Nancy You; Robert E Roses; George J Chang; Miguel A Rodriguez-Bigas; Barry W Feig; Rebecca Slack; Sa Nguyen; John M Skibber |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Diseases of the colon and rectum Volume: 55 ISSN: 1530-0358 ISO Abbreviation: Dis. Colon Rectum Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-11-08 Completed Date: 2013-02-11 Revised Date: 2013-05-08 |
Medline Journal Info:
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Nlm Unique ID: 0372764 Medline TA: Dis Colon Rectum Country: United States |
Other Details:
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Languages: eng Pagination: 1213-9 Citation Subset: IM |
Affiliation:
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Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77230-4008, USA. ynyou@mdanderson.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Female Humans Male Middle Aged Neoplasm Recurrence, Local / pathology, therapy* Neoplasm Staging Postoperative Complications Rectal Neoplasms / pathology, surgery* Retrospective Studies Salvage Therapy / methods* Survival Rate Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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K07 CA133187/CA/NCI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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