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Salvage therapy for recurrent rectal cancer: A single institution cohort analysis

Michael R. DiSiena1, Harold J Wanebo2
1Berkshire Medical Center, Pittsfield, MA;2Roger Williams Medical Center, Providence, RI

Introduction: The Intergroup Study 0114 reviewed salvage therapy for recurrent rectal cancer. Improved control and survival was implemented with aggressive surgical intervention for recurrent disease. The purpose of this study was to determine the outcome of aggressive salvage therapy for recurrent rectal cancer.
Methods: In a retrospective analysis, 175 patients presented with recurrent disease. Recurrences were treated in 136(77.7%); 51(37.5%) received combined multimodality salvage therapy consisting of surgical resection combined with additional chemo/radiation and 87(62.5%) were treated with either surgical resection alone or chemo/radiation alone. Progression-free survival (PFS) and overall survival (OS) were analyzed with the Kaplan-Meier technique and log rank tests.
Results: The median PFS was 22 months in the overall group. The median PFS was 34 months in the combined modality treatment group and 13 months in the patients who received either surgical resection alone or additional chemo/radiation therapy (2 year PFS 62% vs 36.5% and 5 year PFS 24% vs 11%, log rank, p=0.001). The median OS was 52 months in the overall group. Patients who received the combined modality treatment had a median OS of 69 months compared with a median OS of 48 months among the patients who just received surgical resection alone or chemo/radiation therapy alone. The 2 and 5year OS survival curves were non-significant (84% vs 84% and 57% vs 37.5% respectively, log rank, p=0.11).
Conclusions: Aggressive surgical salvage therapy combined with additional chemoradiation treatment seems to have improved PFS in this cohort of patients with recurrent rectal cancers. Although OS was not affected in this study, treatment strategies incorporating newer agents with improved biologic activity in conjunction with surgical management will be needed to determine improve outcome.

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