Desley van Zoggel

Chapter 4 60 Results Basic characteristics Patient and treatment characteristics are summarized in Table 1. LatLRs typically occurred after lymph node-positive and low primary tumours. Only 17 percent of patientswere not irradiated for their primary tumour. The latLRwas typically diagnosed 3–4 years after the primary surgery. Differences between regions Table 2 shows the types of resections performed per region of recurrence. The chance of achieving restoration of rectal continuity decreased if the recurrence was located more distally (P = 0.038). In addition, the lower the recurrence was located, the higher the chance of involvement of anterior organs (P = 0.019). Logically, most piriformis muscle and sacral nerve resections were seen in the middle latLR, and major vascular resections were only performed in recurrences in the upper region. Factors influencing R0 resection rate and complete response rate Of all 51 patients, 7 (14 percent) had a pathologic complete response (pCR) and 28 (55 percent) underwent an R0 resection. Table 3 depicts different factors and their pCR and R0 resection rates. The sex of the patient, region of the LRRC, andwaiting time after CRT did not influence either the pCR rate or the R0 resection rate; however, whether ICTwas orwas not administered significantly influenced the pCR rate. Patientswhowere treated with ICT had a 31 percent pCR rate compared with 8 percent who were not treated with ICT (P = 0.039). This was reflected in the R0 resection rate; patients who received ICT showed an 85 percent R0 resection rate, while patients who did not receive ICT showed an R0 resection rate of 45 percent (P = 0.013). Induction chemotherapy Patients who received ICT had a 2-year LRR rate of 20.9 versus 53.5 percent in patients who did not receive ICT (P = 0.143), while the 2-year DM rate was 56.2 versus 45.8 percent, respectively (P = 0.786), and CSS after 2 years was 75.0 versus 79.5 percent, respectively (P = 0.974). Follow-up of patients who received ICT was too short to calculate 5-year follow-up data. Of the 13 patients who received ICT, 10 had a response on evaluation after three to four courses, and three patients had progression. Of the 10 patients with a response, two had another two to three courses prior to CRT, one had three courses during the waiting period after CRT, and seven had no further chemotherapy before or after CRT.