Purpose: To define the value of radiotherapy alone or in combination with other treatment modalities in salvage and/or palliation of locally recurrent rectal cancer with or without concomitant distant metastases.
Patients and method: A series of 280 patients, treated between 1975 and 1990 was retrospectively reviewed. The patients were divided into 2 groups: 166 patients had a local recurrence only (group 1), 114 presented with simultaneously distant metastases (group 2). In group 1, 50 patients had only radiotherapy, 20 had radiation in combination with surgery, 68 patients had radiation and chemotherapy, and 28 patients had a combination of all 3 treatment modalities. In group 2 these numbers were 41, 7, 59 and 7, respectively. The median follow-up time was 11 months (1 to 118).
Results: The 2- and 5-year survival of group 1 were 33% and 12%. In group 2 the 2-year survival was 9%. The 2- and 5-year symptom-free survival for both groups were 18%/12% and 4%/0%, respectively. There was no significant difference in survival and symptom-free survival between treatment including concomitant 5-FU or 5-FU once a week and treatment without chemotherapy. In the combined treatments which included surgery there was a longer survival and symptom-free survival. In both groups a subanalysis of the patients who had radiation only showed a dose-response relationship for symptom-free survival. This was not the case for survival.
Conclusion: In local recurrence of rectal cancer without detectable distant metastases, radiotherapy and/or surgery have value toward survival and symptom-free survival. Further intense efforts in preventing the local recurrence by improving primary treatment are warranted.