TREATMENT OF LOCALLY RECURRENT RECTAL-CARCINOMA - RESULTS AND PROGNOSTIC FACTORS

Purpose: To assess the local control and survival in patients who rece ived pelvic irradiation for locally recurrent rectal carcinoma, Method s and Materials: The records of 519 patients with locally recurrent re ctal carcinoma treated principally with external-beam radiation therap y between 1975 to 1985 at a single institute were retrospectively revi ewed. These included 326 patients who relapsed locally following previ ous abdominoperineal resection, 151 after previous low anterior resect ion, and 42 after previous local excision or electrocoagulation for th e primary, No patients had received adjuvant radiation therapy or chem otherapy for the primary disease, Concurrent extrapelvic distant metas tases were found in 164 (32%) patients at local recurrence and, in the remaining 355, the relapse was confined to the pelvis, There were 290 men and 229 women whose age ranged from 23 to 91 years (median = 65), Median time from initial surgery to radiation therapy for local recur rence was 18 months (3-138 months), Radiation therapy was given with v arying dose-fractionation schedules, total doses ranging from 4.4 to 6 5.0 Gy (median = 30 Gy) over 1 to 92 days (median = 22 days), For 214 patients who received a total dose greater than or equal to 35 Gy, rad iation therapy was given in 1.8 to 2.5 Gy daily fractions, Results: Th e median survival was 14 months and the median time to local disease p rogression was 5 months from date of pelvic irradiation, The 5-year su rvival was 5%, and the pelvic disease progression-free rate was 7%, Tw elve patients remained alive and free of disease at 5 years after pelv ic irradiation, Upon multivariate analysis, overall survival was posit ively correlated with ECOG performance status (p = 0.0001), absence of extrapelvic metastases (p = 0.0001), long intervals from initial surg ery to radiation therapy for local recurrence (p = 0.0001), total radi ation dose (p = 0.0001), and absence of obstructive uropathy (p = 0.00 13), Pelvic disease progression free rates were positively correlated with ECOG performance status (p = 0.0001), total radiation dose (p = 0 .0001), and previous conservative surgery for the primary (p = 0.02), Conclusions: Survival is poor for patients who develop local recurrenc e following previous surgery for rectal carcinoma. Pelvic radiation th erapy provides only short-term palliation, and future efforts should b e directed to the use of effective adjuvant therapy for patients with rectal carcinoma who are at high risk of local recurrence, (C) 1998 El sevier Science Inc.