Desley van Zoggel

Chapter 2 26 In general, local recurrences occurred within the first 3 years after resection of the primary tumour, with amedian interval of 32 (range 5–201)months for first recurrences and of 17 (range 8–52) months between previous recurrence surgery and index surgery for second and third recurrences. Of the 58 patients in the ICT group, ten required a dose reduction during ICT and six during their CRRT. Four patients in this group were hospitalized during ICT, and one patient during CRRT. In the CCRT-only group, one patient required dose reduction, and four had to be hospitalized. Postoperative complications (Clavien–Dindo grade III–IV) were comparable between groups: 13 (22 percent) in the ICT group and 19 (27 percent) in the CRRT group (P = 0.715). Clear margin and pathological complete response rates Patients who received ICT had a similar R0 resection rate to those who had CRRT alone (55 versus 49 percent respectively; P = 0.506), but exhibited a significantly increased pCR rate (17 versus 4 percent; P = 0.015) (Table 2). The remaining 26 patients in the ICT arm had 23 R1 and three R2 resections, and the 36 remaining in the CRRT-alone arm all had an R1 resection. Table 2. Pathological responses of patients in induction chemotherapy and chemoradiation therapyalone groups ICT + CRRT CRRT alone P-value Total N = 58 N = 71 N = 129 R0 32 (55) 35 (49) 0.506 67 (51.9) pCR 10 (17) 3 (4) 0.015 13 (10.1) Values in parentheses are percentages. ICT induction chemotherapy; CRRTchemoradiation therapy; R0 complete resection; pCRpathological complete response. Overall survival The 3-year OS rate for the 129 patients was 44 percent (median survival 27months), 92 percent in patients who had a pCR, 54 percent in thosewith an R0 resection but no pCR, and 32 percent in patients who had an R1/R2 resection (P = 0.012) (Figure 2). In the ICT group, patients who had a pCR were all alive at the end of follow-up, whereas those with R0 but no pCR or margin-positive patients had a median survival of 23 months (P = 0.039). There were only three R2 resections in the ICT group, and none in the CRRT group; therefore, no separate analyses for resection state were performed. In the CRRT group, only three patients achieved a pCR, so the numbers were too small to perform statistical comparisons; however, one patient with a pCR died from another cause at 10 months.