Population-based study of factors predicting treatment intention in patients with locally recurrent rectal cancer

BackgroundLocal recurrence of rectal cancer (LRRC) is associated with poor survival unless curative treatment is performed. The aim of this study was to investigate predictive factors for treatment with curative intent in patients with LRRC. MethodsPopulation-based data for patients treated for primary rectal cancer between 1995 and 2002, and with LRRC reported as first event were collected from the Swedish Colorectal Cancer Registry and medical records. The associations between patient-, primary tumour- and LRRC-related factors and intention of the treatment for LRRC were determined. The impact of the identified predictive factors on prognosis after treatment with curative intent was also assessed. ResultsA total of 426 patients were included in the study, of whom 149 (350 per cent) received treatment with curative intent. Factors significantly associated with treatment of the LRRC with palliative intent were primary surgery with abdominoperineal resection (odds ratio (OR) 516, 95 per cent c.i. 297 to 897), age at diagnosis of LRRC at least 80years (OR 482, 237 to 980), symptoms at diagnosis (OR 279, 156 to 501) and non-central location of the LRRC (OR 179, 115 to 279). The overall 5-year survival rate was 89 per cent for all patients and 231 per cent among those treated with curative intent. In patients treated with curative intent, factors associated with increased risk of death were age 80years or more (hazard ratio (HR) 244, 95 per cent c.i. 155 to 386), presence of symptoms (HR 192, 120 to 305), non-central tumour location (HR 151, 101 to 226) and presence of hydronephrosis (HR 202, 118 to 344). ConclusionNon-central location of the LRRC, presence of symptoms and age at least 80years at diagnosis of the LRRC were associated with treatment with palliative intent. Defines good selection criteria