Improved outcomes for responders to induction chemotherapy 39 CHAPTER 3 Results Patients and treatment characteristics In total, 132 patients with locally recurrent rectal cancer were treated with induction chemotherapy and subsequent (chemo)(re)irradiation and surgery between January 2010 andDecember 2018. Patient characteristics and characteristics about the primary tumour are presented in Table 1, and Table 2 shows the characteristics of the recurrent tumour. Most patients includedhad a first recurrence (N= 116, 88 percent). Twenty-nine patients (22 percent) had a history of metastases at time of diagnosis of the recurrence, and 35 patients were diagnosed with synchronous metastases (27 percent). Induction chemotherapy consisted of CAPOX in 97 patients (73 percent). In 22 of 97 patients, bevacizumab was added to the induction chemotherapy. Ten patients (8 percent) received FOLFOX. Twenty-five (19 percent) patients received another chemotherapy regimen (mainly FOLFIRI). In the majority of patients, induction chemotherapy was followed by (chemo)reirradiation (82 percent). Consolidation chemotherapy was administered in 15 percent of patients. Pathological response, resection margin and oncological outcomes A pathologic complete response was observed in 22 of 132 patients (17 percent), Mandard 2 in 21 (16 percent), Mandard 3 in 53 (40 percent), Mandard 4 in 31 (24 percent), and Mandard 5 in 5 (4 percent) patients. A clear resection margin was achieved in 83 patients (63 percent), an R1 resection in 46 patients (35 percent), and 3 patients had an R2 resection (2 percent). MedianOS,DFS, LRFS, andMFSforallpatientswere47, 12, 18, and18months, respectively. OS, DFS, LRFS, andMFSwere 52, 13, 21, and 26months for patientswithout synchronous metastases (n=97) and 27, 7, 11, and 8months for patientswith synchronousmetastases (n = 35) [95 percent confidence interval (CI) 0.792–2.968, P = 0.205; 95 percent CI 1.900–4.967, P < 0.001; 95 percent CI 0.833–2.777, P = 0.173; 95 percent CI 2.061–6.306, P < 0.001, respectively]. Due to the differences in oncological outcomes between these two groups, the results of patients with and without synchronous metastases will be discussed separately in the following sections. Patients without synchronous metastases A complete pathologic response was observed in 18 patients (19 percent), a ‘good’ response in 56 patients (Mandard 2–3, 58 percent), and a ‘poor’ response in 23 patients (Mandard 4–5, 24 percent).
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