Desley van Zoggel

Chapter 5 74 Methods Patients The data of consecutive LRRC patients treated at the Catharina Hospital (CZE), a national tertiary referral centre for LRRC, were prospectively collected in a database and retrospectively reviewed. This study selected all LRRC patients who underwent a curative resection between January 2005 and December 2017. Patients with local unresectable disease or untreatable distant metastases and patients with progressive disease during neoadjuvant treatment who did not undergo a resection were excluded. Selected patients were categorized as follows: without metastases (no metastases); with curatively treated synchronous or metachronous metastases with the primary tumour (history of metastases); and with resectable metastases diagnosed simultaneously with the LRRC, during neoadjuvant treatment or perioperatively (synchronous metastases). Patients with both a history of metastases and synchronous metastases were categorized as having ‘synchronous metastases’. This study was approved by the local medical ethics board (Medical Research Ethics Committees United – Nieuwegein, registration number W19.031). Treatment local recurrence The optimal treatment strategy and timing for all patients were determined at a multidisciplinary team (MDT) meeting attended by a specialized surgical oncologist, medical oncologist, radiation oncologist, radiologist, nuclear medicine specialist and pathologist. Patients were eligible for curative treatment if an R0 resection of the LRRC and curative treatment of metastatic disease were achievable. Curative treatment generally comprised neoadjuvant chemoradiotherapy with concomitant capecitabine administered twice daily. Radiotherapy dose was 50-50.4 Gy, delivered in 25-28 fractions of 1.8-2.0 Gy. In the case of previous radiotherapy, the dose was 30-30.6 Gy, delivered in 15-17 fractions of 1.8-2.0 Gy. The gross tumour volume was expanded with a margin of at least 1 cm for the clinical target volume. The planning target volume consisted of the clinical target volume plus a 2 cm margin. Since 2010, induction chemotherapy before chemo(re)irradiation had been introduced as a treatment option to improve local downstaging and, thereby, resectability.