Desley van Zoggel

Chapter 3 36 Patients and methods Patients All patients with locally recurrent rectal cancer treated at the Catharina Hospital Eindhoven, a national tertiary referral centre for patients with advanced rectal cancer, were prospectively collected in a database. All consecutive patients who underwent a resection between January 2010 and December 2018 after neoadjuvant treatment with induction chemotherapy followed by neoadjuvant radiotherapy or reirradiation with or without concomitant chemotherapy were retrospectively identified and reviewed. From2010 until 2014, induction chemotherapywasmostly administered to patientswith irresectable or marginally resectable disease. From 2015 onward, the administration of induction chemotherapy became more common practice and evolved to the local standard of care in 2016. The decision to administer induction chemotherapy was made during a multidisciplinary tumour (MDT) board meeting, including experienced surgeons, medical oncologists, radiation oncologists, radiologists, and nuclear medicine specialists. The present studywas approved by themedical ethics committee (registration number: W19.031). Neoadjuvant treatment regimen The general treatment regimen consisted of three cycles of CAPOX (capecitabine and oxaliplatin) or four cycles of FOLFOX (leucovorin, 5-fluorouracil, oxaliplatin). Induction chemotherapy was followed by radiotherapy with concomitant chemotherapy. Radiotherapy dose depended on whether the patient had received previous radiotherapy. In radiotherapy-naive patients, full-course radiotherapy was delivered with a cumulative dose of 45–50 Gy in 25 fractions of 1.8–2 Gy. In case of previous radiotherapy, reirradiation consisted of 30–30.6 Gy in 15–17 fractions of 1.8–2 Gy. Concomitant chemotherapy agent was capecitabine (825 mg/m2 bid on radiotherapy days). All patients were assessed for radiological response 2–3 weeks after completing the induction chemotherapy and 4–6 weeks after finishing the subsequent (chemo) radiotherapy. Restaging consisted of a pelvicMRI and a thoracoabdominal CT scanwith or without the addition of FDG-PET. All restaging imaging was discussed during the MDT meeting in our tertiary referral centre. In case of a radiological good response to induction chemotherapy, consolidation chemotherapy during thewaiting time between (chemo)radiotherapy and surgery was considered. Consolidation chemotherapy consisted of one or two cycles of CAPOX or FOLFOX.