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Clin Colon Rectal Surg 2002; 15(1): 063-070
DOI: 10.1055/s-2002-23569
DOI: 10.1055/s-2002-23569
Multimodality Management of Recurrent Rectal Cancer
Claudio Belluco, Enrico Melega, Enzo Mammano, Salvatore Pucciarelli, Donato Nitti, Mario Lise- Department of Oncological and Surgical Sciences, University of Padova, Italy
Further Information
Publication History
Publication Date:
03 April 2002 (online)
ABSTRACT
The treatment of recurrent rectal cancer is a major challenge for surgeons, radiotherapists, and medical oncologists. In recent years, encouraging results have been reported with multimodality treatment. The goal of the present article is to outline strategies for the diagnosis and treatment of recurrent rectal cancer, based on data reported in the literature and our own experience. Following histologic confirmation, the pattern of recurrent disease and resectability are evaluated by a thorough preoperative diagnostic workup that includes clinical assessment, endoscopy, and imaging studies. Surgical treatment, tailored according to the pattern of pelvic recurrence, aims to achieve complete disease removal. However, when curative resection is infeasible, chemotherapy and preoperative or intraoperative radiotherapy are utilized in order to improve resectability rate and survival. A variety of different approaches have been proposed for the palliation of symptoms in patients with advanced local recurrent disease not amenable to multimodality treatment.
KEYWORD
Recurrent rectal cancer - multimodality treatment - surgery - radiotherapy - chemotherapy
REFERENCES
- 1 Pahlman L, Glimelius B. The value of adjuvant radio(chemo)therapy for rectal cancer. Eur J Cancer . 1995; 31 1347-1350
- 2 Rao A R, Kagan A R, Chan P M. Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon. Cancer . 1981; 48 1492-1495
- 3 Abulafi A M, Williams N S. Local recurrence of colorectal cancer: the problem, mechanism, management and adjuvant therapy. Br J Surg . 1994; 81 7-19
- 4 Michelassi F, Vannucci L, Ayala J J. Local recurrence after curative colorectal adenocarcinoma. Surgery . 1990; 108 787-793
- 5 Pilipshen S J, Heilweil M, Quan S H. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer . 1984; 53 1354-1362
- 6 Miller A R, Cantor S B, Peoples G E. Quality of life and cost effectiveness analysis of therapy for locally recurrent rectal cancer. Dis Colon Rectum . 2000; 43 1695-1701
- 7 Salo J C, Paty P B, Guillem J. Surgical salvage of recurrent rectal carcinoma after curative resection: a 10-year experience. Ann Surg Oncol . 1999; 6 171-177
- 8 Mohiuddin M, Hayne M, Regine W F. Prognostic significance of postchemoradiation stage following preoperative chemotherapy and radiation for advanced/recurrent rectal cancers. Int J Radiat Oncol Biol Phys . 2000; 48 1075-1080
- 9 Harrison L B, Minsk B D, Enker W E. High dose rate intraoperative radiation therapy (HDR-IORT) as part of the management strategy for locally advanced primary and recurrent rectal cancer. Int J Radiat Oncol Biol Phys . 1998; 42 325-330
- 10 Vanhoefer U, Harstrick A, Achterrath W. Irinotecan in the treatment of colorectal cancer. Clinical overview. J Clin Oncol . Mar 1; 19 1501-1518
- 11 Zalcberg J R, Cunningham D, Van Cutsem E. Tomudex (ZD 1694), a novel thymidylate syntase inhibitor has substantial activity in the treatment of patients with advanced colorectal cancer. J Clin Oncol . 1996; 14 716-721
- 12 Pelley E J. Oxaliplatin: a new agent for colorectal cancer. Curr Oncol Rep . 2001; 3 147-155
- 13 Safi F, Link K H, Beger H G. Is follow-up of colorectal cancer patients worthwhile?. Dis Colon Rectum . 1993; 36 636-644
- 14 Schiessel R, Wunderlich M, Herbst F. Local recurrence of colorectal cancer: effect of early detection and aggressive surgery. Br J Surg . 1986; 73 342-344
- 15 Guillem J G, Ruo L. Strategies in operative therapy for locally recurrent rectal cancer. Semin Colon Rectal Surg . 1998; 9 259-268
- 16 Pema P J, Bennett W F, Bova J G. CT vs MRI in diagnosis of recurrent rectosigmoid carcinoma. J Comput Assist Tomogr . 1994; 18 256-261
- 17 Balzarini L, Ceglia E, D'Ippolito G. Local recurrence of rectosigmoid cancer: what about the choice of MRI for diagnosis?. Gastrointest Radiol . 1990; 15 338-342
- 18 Falk P M, Gupta N C, Thorson A G. Positron emission tomography for preoperative staging of colorectal carcinoma. Dis Colon Rectum . 1994; 37 153-156
- 19 Beets G, Penninckx F, Schiepers C. Clinical value of whole-body positron emission tomography with [18F] fluoro-deoxyglucose in recurrent colorectal cancer. Br J Surg . 1994; 81 1666-1670
- 20 Schiepers C, Penninckx F, De Vadder N. Contribution of PET in the diagnosis of recurrent colorectal cancer: comparison with conventional imaging. Eur J Surg Oncol . 1995; 21 517-522
- 21 Lai D T, Fulham M, Staphen M S. The role of whole-body positron emission tomography with [18F] fluoro-deoxyglucose in identifying operable colorectal cancer metastases to the liver. Arch Surg . 1996; 131 703-707
- 22 Haberkorn U, Strauss L G, Dimitrakopoulou A. PET studies of fluoro-deoxyglucose metabolism in patients with recurrent colorectal tumors receiving radiotherapy. J Nucl Med . 1991; 32 1485-1490
- 23 Jarv V, Blomqvist L, Holm T. Added value of CEA scintigraphy in the detection of recurrence of rectal carcinoma. Acta Radiol . 2000; 41 629-633
- 24 Scneebaum S, Papo J, Graif M. Radioimmunoguided surgery benefits for recurrent colorectal cancer. Ann Surg Oncol . 1997; 4 369-370
- 25 Bertsch D J, Burak Jr E W, Young D C. Radioimmunoguided surgery system improves survival for patients with recurrent colorectal cancer. Surgery . 1995; 118 634-638
- 26 Yeung R S, Moffat F L, Falk R E. Pelvic exenteration for recurrent colorectal carcinoma: a review. Cancer Invest . 1994; 12 176-188
- 27 Wiggers T, de Vries R M, Veeze-Kupyers B. Surgery for local recurrence of rectal carcinoma. Dis Colon Rectum . 1996; 39 323-328
- 28 Lopez-Kostner F, Fazio V W, Vignali A. Locally recurrent rectal cancer. Predictors and success of salvage surgery. Dis Colon Rectum . 2001; 44 173-178
- 29 Hafner G H, Herrera L, Petrelli N J. Morbidity and mortality after pelvic exenteration for colorectal adenocarcinoma. Ann Surg . 1992; 215 63-67
- 30 Suzuki K, Dozois R R, Devine R M. Curative reoperations for locally recurrent rectal cancer. Dis Colon Rectum . 1996; 39 730-736
- 31 Mannaerts G HH, Rutten H JT, Matijn H. Abdominosacral resection for primary irresectable and locally recurrent rectal cancer. Dis Colon Rectum . 2001; 44 806-814
- 32 Huguier M, Houry S. Treatment of local recurrence of rectal cancer. Am J Surg . 1998; 175 288-292
- 33 Schneebaum S, Arnold M W, Young D. Role of carcinoembryonic antigen in predicting resectability of recurrent colorectal cancer. Dis Colon Rectum . 1993; 36 810-815
- 34 Cohen A M, Minsky B D. Aggressive surgical management of locally advanced primary and recurrent rectal cancer. Dis Colon Rectum . 1990; 33 432-438
- 35 Delpero J R, Pol B, Le Treut P Y. Surgical resection for locally recurrent colorectal adenocarcinoma. Br J Surg . 1998; 85 372-376
- 36 Zacherl J, Schiessel R, Windhager R. Abdominosacral resection of recurrent rectal cancer in the sacrum. Dis Colon Rectum . 1999; 42 1035-1040
- 37 Wanebo H J, Koness R J, Vezeridis M P. Pelvic resection of recurrent rectal cancer. Ann Surg . 1994; 220 586-595
- 38 Brophy P F, Hoffman J P, Eisenberg B L. The role of pallitative pelvic exenteration. Am J Surg . 1994; 167 386-390
- 39 Gagliardi G, Hawley P R, Hershman M J, Arnott S J. Prognostic factors in surgery for local recurrence of rectal cancer. Brit J Surg . 1995; 82 1401-1405
- 40 Ogunbiyi O A, McKenna K, Birnbaum E H. Aggressive surgical management of recurrent rectal cancer: is it worthwhile?. Dis Colon Rectum . 1997; 40 150-155
- 41 Martin E W, Carey L C. Second-look surgery for colorectal cancer. Ann Surg . 1991; 214 321-327
- 42 Lasser P, Doidy L, Elias D. Total pelvic exenteration and rectal cancer. Apropos of 20 cases. Chirurgie . 1999; 124 252-257
- 43 Lise M, Melega E, Pucciarelli S. Surgery for local recurrence from rectal cancer. 52nd Cancer Symposium, Orlando,Abstracts 1997 : 97
- 44 Mohiuddin M, Marks G M, Lingareddy V, Marks J. Curative surgical resection following reirradiation for recurrent rectal cancer. Int J Radiat Oncol Biol Phys . 1997; 39 643-649
- 45 Hu Kennet S, Harrison L B. Results and complications of surgery combined with intraoperative radiation therapy for the treatment of locally advanced or recurrent cancer in the pelvis. Semin Surg Oncol . 2000; 18 269-278
- 46 Gunderson L L, Dozois R R. Intraoperative irradiation for locally advanced colorectal carcinomas. Perspect Colon Rectal Surg . 1992; 5 1-24
- 47 Harrison L B, Enker W E, Anderson L. High dose rate intraoperative radiation therapy for colorectal cancer. Oncology . 1995; 9(7) 679-683
- 48 Harrison L B, Enker W E, Anderson L. High dose rate intraoperative radiation therapy for colorectal cancer. Oncology . 1995; 9(8) 737-741
- 49 Mannaerts G HH, Martijn H, Crommelin M A. Intraoperative electron beam radiation therapy for locally recurrent rectal carcinoma. Int J Radiat Oncol Biol Phys . 1999; 45 297-308
- 50 Hashiguchi Y, Sekine T, Sakamoto H. Intraoperative irradiation after surgery for locally recurrent rectal cancer. Dis Colon Rectum . 1999; 42 886-895
- 51 Lowy A M, Rich T A, Skibber J M. Preoperative infusional chemoradiation, selective intraoperative radiation, and resection for locally advanced pelvic recurrence of colorectal adenocarcinoma. Ann Surg . 1996; 223 177-185
- 52 Alektiar K M, Zelefsky M J, Paty P B. High-dose-rate intraoperative brachytherapy for recurrent colorectal cancer. Int J Radiat Oncol Biol Phys . 2000; 48 219-226
- 53 Gunderson L L, Nelson H, Martenson J A. Intraoperative electron and external beam irradiation with or without 5-fluorouracil and maximum surgical resection for previously unirradiated, locally recurrent colorectal cancer. Dis Colon Rectum . 1996; 39 1379-1395
- 54 Rodel C, Grabenbauer G G, Matzel K E. Extensive surgery after high-dose chemoradiotherapy for locally advanced recurrent rectal cancer. Dis Colon Rectum . 2000; 43 312-319
- 55 Shaw E G, Gunderson L L, Martin J K. Peripheral nerve and ureteral tolerance to intraoperative radiation therapy: clinical and dose-response analysis. Radiother Oncol . 1990; 18 247-255
- 56 Nakfoor B M, Willet C G, Shellito P C. The impact of 5-fluorouracil and intraoperative electron beam radiation therapy on outcome of patients with locally advanced primary rectal and rectosigmoid cancer. Ann Surg . 1998; 228 194-200
- 57 Magrini S, Nelson H, Gunderson L L, Sim F H. Sacropelvic resection and intraoperative electron irradiation in the management of recurrent anorectal cancer. Dis Colon Rectum . 1996; 39 1-9
- 58 Noyes R D, Weiss S M, Krall J M. Surgical complications of intraoperative radiation therapy; the Radiation Therapy Oncology Group Experience. J Surg Oncol . 1992; 50 209-215
- 59 Dobrowsky W, Schmid A P. Radiotherapy of presacral recurrence following radical surgery for rectal carcinoma. Dis Colon Rectum . 1985; 28 917-919
- 60 Pacini P, Cionin L, Pirtoll L. Symptomatic recurrence of carcinoma of the rectum and sigmoid: the influence of radiotherapy on the quality of life. Dis Colon Rectum . 1986; 29 685-688
- 61 Lingareddy V, Ahmad N R, Mohiuddin M. Palliative reirradiation for recurrent rectal cancer. Int J Radiat Oncol Biol Phys . 1997; 38 785-790
- 62 Goes R N, Beart Jr W R, Simons A J. Use of brachytherapy in management of locally recurrent rectal cancer. Dis Colon Rectum . 1997; 40 1177-1179
- 63 Meijer S, de Rooij D P, Derksen E J. Cryosurgery for locally recurrent rectal cancer. Eur J Surg Oncol . 1992; 18 255-257
- 64 Guadagni S, Fiorentini G, Palumbo G. Hypoxic pelvic perfusion with mitomycin C using a simplified balloon-occlusion technique in the treatment of patients with unresectable locally recurrent rectal cancer. Arch Surg . 2001; 136 105-112
- 65 Vaglini M, Cascinelli F, Chiti A. Isolated pelvic perfusion for the treatment of unresectable primary or recurrent rectal cancer. Tumori . 1996; 459-462
- 66 Harris G J, Senagore A J, Lavery I C, Fazio V W. The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices. Am J Surg . 2001; 181(6) 499-506