BACKGROUND: The aim of this study was to evaluate the efficacy and morbidity of intraoperative radiation therapy (IORT) for advanced colorectal cancer. METHODS: All patients undergoing IORT for locally advanced rectal cancer from 2001-2009 were reviewed for cancer recurrence, survival, and procedure-related morbidity. Cumulative event rates were estimated using the method of Kaplan and Meier. RESULTS: Twenty-nine patients with locally advanced (n = 8) or recurrent (n = 21) rectal cancers were treated with IORT and resection. Surgical interventions included low anterior resection, abdominoperineal resection, pelvic exenteration, and a variety of non-anatomic resections of pelvic recurrences. R(0) resections were achieved in 16 patients, while R(1) resections were achieved in 10, and margins were grossly positive in 3 patients. IORT was delivered to all patients over a median area of 48 (42-72) cm(2) at a median dose of 12 (12-15) Gy. Local and overall recurrence rates were 24 % (locally advanced group) and 45 % (recurrent group). Median disease-free and overall survival were 25 and 40 months respectively at a median follow-up of 26 (18-42) months. The short-term (≤30 days) complication rate was 45 %. Eight patients developed local wound complications, 5 of which required operative intervention. Four patients developed intra-abdominal abscesses requiring drainage. Long-term (>30 days) complications were identified in 11 patients (38 %) and included long-term wound complications (n = 3), ureteral obstruction requiring stenting (n = 1), neurogenic bladder (n = 3), enteric fistulae (n = 2), small bowel obstruction (n = 1), and neuropathic pain (n = 1). CONCLUSIONS: Intraoperative brachytherapy is a viable IORT option during pelvic surgery for locally advanced or recurrent colorectal cancer but is associated with high postoperative morbidity. Whether intraoperative brachytherapy can improve local recurrence rates for locally advanced or recurrent colorectal cancer will require further prospective investigation.
BACKGROUND: The aim of this study was to evaluate the efficacy and morbidity of intraoperative radiation therapy (IORT) for advanced colorectal cancer. METHODS: All patients undergoing IORT for locally advanced rectal cancer from 2001-2009 were reviewed for cancer recurrence, survival, and procedure-related morbidity. Cumulative event rates were estimated using the method of Kaplan and Meier. RESULTS: Twenty-nine patients with locally advanced (n = 8) or recurrent (n = 21) rectal cancers were treated with IORT and resection. Surgical interventions included low anterior resection, abdominoperineal resection, pelvic exenteration, and a variety of non-anatomic resections of pelvic recurrences. R(0) resections were achieved in 16 patients, while R(1) resections were achieved in 10, and margins were grossly positive in 3 patients. IORT was delivered to all patients over a median area of 48 (42-72) cm(2) at a median dose of 12 (12-15) Gy. Local and overall recurrence rates were 24 % (locally advanced group) and 45 % (recurrent group). Median disease-free and overall survival were 25 and 40 months respectively at a median follow-up of 26 (18-42) months. The short-term (≤30 days) complication rate was 45 %. Eight patients developed local wound complications, 5 of which required operative intervention. Four patients developed intra-abdominal abscesses requiring drainage. Long-term (>30 days) complications were identified in 11 patients (38 %) and included long-term wound complications (n = 3), ureteral obstruction requiring stenting (n = 1), neurogenic bladder (n = 3), enteric fistulae (n = 2), small bowel obstruction (n = 1), and neuropathic pain (n = 1). CONCLUSIONS: Intraoperative brachytherapy is a viable IORT option during pelvic surgery for locally advanced or recurrent colorectal cancer but is associated with high postoperative morbidity. Whether intraoperative brachytherapy can improve local recurrence rates for locally advanced or recurrent colorectal cancer will require further prospective investigation.
Authors: Floris T J Ferenschild; Maarten Vermaas; Joost J M E Nuyttens; Wilfried J Graveland; Andreas W K S Marinelli; Joost R van der Sijp; Theo Wiggers; Cornelis Verhoef; Alexander M M Eggermont; Johannes H W de Wilt Journal: Dis Colon Rectum Date: 2006-09 Impact factor: 4.585
Authors: K M Alektiar; M J Zelefsky; P B Paty; J Guillem; L B Saltz; A M Cohen; B D Minsky Journal: Int J Radiat Oncol Biol Phys Date: 2000-08-01 Impact factor: 7.038
Authors: M G Haddock; L L Gunderson; H Nelson; S S Cha; R M Devine; R R Dozois; B G Wolff Journal: Int J Radiat Oncol Biol Phys Date: 2001-04-01 Impact factor: 7.038
Authors: L B Harrison; B D Minsky; W E Enker; B Mychalczak; J Guillem; P B Paty; L Anderson; C White; A M Cohen Journal: Int J Radiat Oncol Biol Phys Date: 1998-09-01 Impact factor: 7.038
Authors: Vincenzo Valentini; Claudio Coco; Gianluca Rizzo; Alberto Manno; Antonio Crucitti; Claudio Mattana; Carlo Ratto; Alessandro Verbo; Fabio M Vecchio; Brunella Barbaro; Maria A Gambacorta; Caterina Montoro; Maria C Barba; Luigi Sofo; Valerio Papa; Roberta Menghi; Domenico M D'Ugo; Giovanbattista Doglietto Journal: Surgery Date: 2009-03-21 Impact factor: 3.982
Authors: I Shaikh; W Aston; G Hellawell; D Ross; S Littler; D Burling; M Marshall; J M A Northover; A Antoniou; J T Jenkins Journal: Tech Coloproctol Date: 2014-11-08 Impact factor: 3.781
Authors: Stanley K T Yu; Aneel Bhangu; Diana M Tait; Paris Tekkis; Andrew Wotherspoon; Gina Brown Journal: Cancer Med Date: 2013-12-16 Impact factor: 4.452
Authors: Felipe A Calvo; Claudio V Sole; Harm J Rutten; Wim J Dries; Miguel A Lozano; Mauricio Cambeiro; Philip Poortmans; Luis González-Bayón Journal: Clin Transl Radiat Oncol Date: 2020-06-17