Management of recurrent rectal cancer: A population based study in greater Amsterdam

Table 1 Initially applied radiotherapy in surgically treated, primary rectal carcinoma patients according to pTNM-stage in Greater Amsterdam, the Netherlands, 1998 to 2000

Stage of disease	Number of cases (% of total)	Radiotherapy, number of patients (%)
		No RT	Postoperative RT	Preoperative RT
I	209 (33)	115 (55)	1 (0)	93 (45)
IIA	180 (28)	72 (40)	26 (14)	82 (46)
IIB	20 (3)	2 (10)	6 (30)	12 (60)
IIIA	32 (5)	8 (25)	11 (34)	13 (41)
IIIB	113 (18)	26 (23)	32 (28)	55 (49)
IIIC	72 (11)	13 (18)	23 (32)	36 (50)
Unknown	6 (1)	2 (33)	-	4 (67)
Total	632	238 (38)	99 (16)	295 (47)

RT: Radiotherapy.

Table 2 Secondary treatment of local recurrence (in the absence of distant dissemination) according to treatment with radiotherapy and stage at initial diagnosis (after a macroscopically radical resection obtained with TME)

Secondary treatment	Stage and treatment with radiotherapy at initial diagnosis
	Stage I			Stage II			Stage III			Total n (%)
	No RT	Post RT	Pre RT	No RT	Post RT	Pre RT	No RT	Post RT	Pre RT
Radical surgery1 (± radiotherapy and/or chemotherapy)	3	-	1	3	-	1	1	-	1	10 (3)
Non-radical surgery1 (± radiotherapy and/or chemotherapy)	-	-	-	2	1	2	-	3	-	8 (2)
Radiotherapy and/orchemotherapy without surgery	2	-	-	1	1	-	1	2	-	7 (2)
Best supportive care	1	-	-	-	1	3	1	-	1	7 (2)
Total	6	-	1	6	3	6	3	5	2	32

¹Radical surgery was defined as surgery without microscopically residual disease; all other surgery cases were classified as non-radical. No RT: No radiotherapy; Post RT: Postoperative radiotherapy; Pre RT: Preoperative radiotherapy.

Table 3 Multivariate analysis of potentially prognostic factors for improved survival after treatment of patients with a locally recurrent rectal carcinoma in Greater Amsterdam (cases with distant dissemination and/or macroscopic residual disease at time of initial treatment are excluded)

Parameter	Number of cases	HR (95% CI)
Sex
Male (reference) vs female	33/29	1.9 (0.9-3.7)
Radiotherapy at initial treatment
No radiotherapy	23	1.0
Preoperative radiotherapy	23	1.2 (0.6-2.5)
Postoperative radiotherapy	16	0.9 (0.4-1.8)
Distant dissemination at time of local recurrence
Absent (reference) vs present	32/30	0.8 (0.4-1.6)
Surgical treatment of locally recurrent disease
No surgery	42	1.0
Radical surgery	10	0.1 (0.0-0.3)
Non-radical surgery	10	0.5 (0.2-1.3)

HR > 1: Worse prognosis; HR < 1: Better prognosis.

Table 4 Treatment of distant dissemination in patients initially treated with a macroscopically radical local resection obtained with TME in the absence of distant metastasis

Treatment	No local recurrence		Local recurrence1		Total
	n	%	n	%	n	%
Surgery1 (± radiotherapy and/or chemotherapy)	18	19	2	7	20	16
Radiotherapy and/or chemotherapy	54	57	13	43	67	54
Other	1	1	2	7	3	2
Best supportive care	21	22	13	43	34	27
Total	94		30		124

¹Synchronous with distant metastasis or prior to distant metastasis.