[Therapy of locally recurrent rectal carcinoma]

[Imaging: The oncologist's perspective]

CLINICAL ISSUE

Modern oncology has implemented several novel modalities, which increasingly warrant interdisciplinarity, dedicated imaging methods as well as intensive communication between imager and oncologists.

STANDARD TREATMENT

The classical pillars of cancer treatment are surgery, radiotherapy, and chemotherapy.

TREATMENT INNOVATIONS

Evidence-based oncology, radio-oncology, and surgery, individualized precision oncology, novel drug classes, immuno-oncology, minimally invasive diagnostic and treatment methods.

DIAGNOSTIC WORK-UP

Standard imaging methods are undergoing constant innovation and are being supplemented by specific radiotracers that can be used for radionuclide therapy. Adapted response criteria are to be used in the context of targeted therapy or checkpoint inhibitors.

PERFORMANCE AND ACHIEVEMENT

Modern cancer treatment enables improved tumor control. Due to its complexity, however, it increasingly warrants structured reporting and intense communication between imager and oncologists, to make best use of its potential.

Locally recurrent colorectal cancer: results of surgical therapy

PURPOSE

Up to 20 % of colorectal cancer patients develop recurrent disease despite standardized surgical techniques and multimodal treatment strategies. Radical resection is the central component of curative therapy in these cases. The aim of this study was to evaluate treatment results in patients with locoregionally recurrent colorectal cancer.

METHODS

From January 1995 to December 2007, surgery was performed for recurrent colorectal cancer in 82 patients who had undergone curative (R0) resection of their primary tumor. Assessment included patient, tumor and treatment characteristics, postoperative complications, and time without re-recurrence; recurrence-free and overall survival rates were calculated according to the Kaplan-Meier method.

RESULTS

Resection was performed in 60 of the 82 patients (73 %), repeat R0 resection in 52 % (31/60). Patients had a postoperative morbidity of 39 % (31/82), a relaparotomy rate of 13 % (11/82), and a lethality of 7 % (6/82). Forty-eight percent of all surgically-treated patients received a permanent stoma. Re-recurrence was seen in 52 % (16/31). R0 resection was associated with a 5-year survival rate of 35 % (11/31).

CONCLUSIONS

Extensive reinterventions often enable repeat R0 resection. Despite relevant morbidity, the lethality appears to be acceptable. Decisive for the prognosis is re-recurrence.