• D M G I van Zoggel, S J Bosman, M Kusters, Nieuwenhuijzen G A P GAP Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., J S Cnossen, G J Creemers, G van Lijnschoten, and Rutten H J T HJT Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. GROW School of O.
• Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
• Br J Surg. 2018 Mar 1; 105 (4): 447-452.

BackgroundA significant number of patients treated for locally recurrent rectal cancer have local or systemic failure, especially after incomplete surgical resection. Neoadjuvant treatment regimens in patients who have already undergone preoperative (chemo)radiotherapy for the primary tumour are limited. The objective of the present study was to evaluate the influence of a neoadjuvant regimen incorporating induction chemotherapy (ICT) in patients with locally recurrent rectal cancer who had preoperative (chemo)radiotherapy for the primary cancer or an earlier local recurrence.MethodsPatients were treated with a sequential neoadjuvant regimen including three or four cycles of 5-fluorouracil and oxaliplatin-containing chemotherapy. When no progressive disease was found at evaluation, neoadjuvant treatment was continued with chemoradiation therapy (CRRT) using 30 Gy with concomitant capecitabine. If there was a response to ICT, the patient was advised to continue with systemic chemotherapy after CRRT as consolidation chemotherapy while waiting for resection. These patients were compared with patients who received CRRT alone in the same time interval.ResultsOf 58 patients who had ICT, 32 (55 per cent) had surgery with clear resection margins, of whom ten (17 per cent) exhibited a pathological complete response (pCR). The remaining 26 patients had 23 R1 and three R2 resections. In 71 patients who received CRRT, a similar rate of R0 (35 patients) and R1 (36) resection was found (P = 0·506), but only three patients (4 per cent) had a pCR (P = 0·015).ConclusionThe incorporation of ICT in neoadjuvant regimens for locally recurrent rectal cancer is a promising strategy.© 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

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