Patterns of failure in patients with early onset (synchronous) resectable liver metastases from rectal cancer Journal Article

Authors: Butte, J. M.; Gonen, M.; Ding, P.; Goodman, K. A.; Allen, P. J.; Nash, G. M.; Guillem, J.; Paty, P. B.; Saltz, L. B.; Kemeny, N. E.; DeMatteo, R. P.; Fong, Y.; Jarnagin, W. R.; Weiser, M. R.; D'Angelica, M. I.
Article Title: Patterns of failure in patients with early onset (synchronous) resectable liver metastases from rectal cancer
Abstract: Background: The optimal combination of available therapies for patients with resectable synchronous liver metastases from rectal cancer (SLMRC) is unknown, and the pattern of recurrence after resection has been poorly investigated. In this study, the authors examined recurrence patterns and survival after resection of SLMRC. Methods: Consecutive patients with SLMRC (disease-free interval, ≤12 months) who underwent complete resection of the rectal primary and liver metastases between 1990 and 2008 were identified from a prospective database. Demographics, tumor-related variables, and treatment-related variables were correlated with recurrence patterns. Competing risk analysis was used to determine the risk of pelvic and extrapelvic recurrence. Results: In total, 185 patients underwent complete resection of rectal primary and liver metastases. One hundred eighty patients (97%) received chemotherapy during their treatment course, and 91 patients (49%) received pelvic radiation therapy either before (N = 65; 71.4%), or after (N = 26; 28.6%) rectal resection. The 5-year disease-specific survival rate was 51% for the entire cohort with a median follow-up of 44 months for survivors. One hundred thirty patients (70%) developed a recurrence: Eighteen patients (10%) had recurrences in the pelvis in combination with other sites, and 7 of these (4%) had an isolated pelvic recurrence. Recurrence pattern did not correlate with survival. Competing risk analysis demonstrated that the likelihood of a pelvic recurrence was significantly lower than that of an extrapelvic recurrence (P ;lt&.001). Conclusions: Of the patients with SLMRC who developed recurrent disease, systemic sites were overwhelmingly more common than pelvic recurrences. The current results indicated that the selective exclusion of radiotherapy may be considered in patients who are diagnosed with simultaneous disease. Cancer 2012. © 2012 American Cancer Society.
Keywords: adolescent; adult; cancer chemotherapy; cancer survival; aged; aged, 80 and over; middle aged; cancer surgery; young adult; major clinical study; cancer recurrence; liver neoplasms; cancer patient; cancer radiotherapy; combined modality therapy; outcome assessment; follow up; colorectal cancer; cohort analysis; cancer survivor; risk assessment; liver metastasis; liver; correlation analysis; radiation therapy; cancer classification; rectal neoplasms; outcomes; recurrence pattern; colorectal metastases; synchronous liver metastasis from rectal cancer
Journal Title: Cancer
Volume: 118
Issue: 21
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2012-11-01
Start Page: 5414
End Page: 5423
Language: English
DOI: 10.1002/cncr.27567
PROVIDER: scopus
PUBMED: 22517058
Notes: --- - "Export Date: 3 December 2012" - "CODEN: CANCA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Leonard B Saltz
    580 Saltz
  2. Philip B Paty
    364 Paty
  3. Ronald P DeMatteo
    597 DeMatteo
  4. Karyn A Goodman
    244 Goodman
  5. Mithat Gonen
    701 Gonen
  6. Jose Guillem
    363 Guillem
  7. Martin R Weiser
    338 Weiser
  8. Peter Allen
    436 Allen
  9. William R Jarnagin
    583 Jarnagin
  10. Yuman Fong
    741 Fong
  11. Peirong Ding
    8 Ding
  12. Garrett Nash
    130 Nash
  13. Nancy Kemeny
    346 Kemeny