BACKGROUND: We evaluated outcomes of intraoperative radiotherapy delivered with focal high-dose-rate (HDR) brachytherapy [intraoperative radiotherapy (IORT)] in the management of locally recurrent (LR) and locally advanced (LA) primary T4 colorectal carcinoma (CRC). LR CRC or LA primary disease is a clinical challenge due to the difficulty in obtaining negative margins after radical surgery and the high risk of subsequent recurrence. Few data exist on long-term outcomes of patients treated with surgery and HDR-IORT for LR or LA primary CRC. METHODS: Three hundred CRC patients underwent HDR-IORT to the pelvis with gross surgical resection during November 1992-December 2007. Median follow-up for surviving patients was 53 (range 5-216) months. Eighty-eight patients (29 %) were treated for LA primary and 212 (71 %) LR disease. HDR-IORT was delivered using an iridium-192 remote afterloader and a Harrison-Anderson-Mick applicator. Median IORT dose was 1,500 (range 1,000-2,000) cGy. RESULTS: Five-year overall survival probability was 49 %. Positive margin status was associated with inferior overall survival and disease-free survival. Competing-risks analysis for time to local failure and distant metastases identified a 5-year cumulative incidence of local failure and distant metastases of 33 and 47 %, respectively. Five-year cumulative incidence of local failure was 22 % for the LA group and 38 % in the LR group. Five-year probability of disease-free survival was 48 and 31 % for LA and LR patients, respectively, and 5-year probability of overall survival was 56 and 45 % for LA and LR patients, respectively. CONCLUSIONS: HDR-IORT combined with resection results in encouraging local control rates with acceptable toxicity for patients with locally aggressive CRC.
BACKGROUND: We evaluated outcomes of intraoperative radiotherapy delivered with focal high-dose-rate (HDR) brachytherapy [intraoperative radiotherapy (IORT)] in the management of locally recurrent (LR) and locally advanced (LA) primary T4 colorectal carcinoma (CRC). LR CRC or LA primary disease is a clinical challenge due to the difficulty in obtaining negative margins after radical surgery and the high risk of subsequent recurrence. Few data exist on long-term outcomes of patients treated with surgery and HDR-IORT for LR or LA primary CRC. METHODS: Three hundred CRC patients underwent HDR-IORT to the pelvis with gross surgical resection during November 1992-December 2007. Median follow-up for surviving patients was 53 (range 5-216) months. Eighty-eight patients (29 %) were treated for LA primary and 212 (71 %) LR disease. HDR-IORT was delivered using an iridium-192 remote afterloader and a Harrison-Anderson-Mick applicator. Median IORT dose was 1,500 (range 1,000-2,000) cGy. RESULTS: Five-year overall survival probability was 49 %. Positive margin status was associated with inferior overall survival and disease-free survival. Competing-risks analysis for time to local failure and distant metastases identified a 5-year cumulative incidence of local failure and distant metastases of 33 and 47 %, respectively. Five-year cumulative incidence of local failure was 22 % for the LA group and 38 % in the LR group. Five-year probability of disease-free survival was 48 and 31 % for LA and LRpatients, respectively, and 5-year probability of overall survival was 56 and 45 % for LA and LRpatients, respectively. CONCLUSIONS: HDR-IORT combined with resection results in encouraging local control rates with acceptable toxicity for patients with locally aggressive CRC.
Authors: L L Gunderson; H Nelson; J A Martenson; S Cha; M Haddock; R Devine; J M Fieck; B Wolff; R Dozois; M J O'Connell Journal: Dis Colon Rectum Date: 1996-12 Impact factor: 4.585
Authors: J E Tepper; L L Gunderson; E Orlow; A M Cohen; S E Hedberg; W U Shipley; P H Blitzer; T Rich Journal: Int J Radiat Oncol Biol Phys Date: 1984-10 Impact factor: 7.038
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: 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: K Suzuki; L L Gunderson; R M Devine; A L Weaver; R R Dozois; D M Ilstrup; J A Martenson; M J O'Connell Journal: Cancer Date: 1995-02-15 Impact factor: 6.860
Authors: Fabian A Holman; Michael G Haddock; Leonard L Gunderson; Miranda Kusters; Grard A P Nieuwenhuijzen; Hetty A van den Berg; Heidi Nelson; Harm J T Rutten Journal: J Gastrointest Oncol Date: 2016-12
Authors: Gil'ad N Cohen; Karen Episcopia; Seng-Boh Lim; Thomas J LoSasso; Mark J Rivard; Amandeep S Taggar; Neil K Taunk; Abraham J Wu; Antonio L Damato Journal: Brachytherapy Date: 2017-08-18 Impact factor: 2.362
Authors: Thomas G Bird; Samuel Y Ngan; Julie Chu; René Kroon; Andrew C Lynch; Alexander G Heriot Journal: Int J Colorectal Dis Date: 2018-02-21 Impact factor: 2.571
Authors: Li Ma; Junhao Qiang; Heliang Yin; Lin Lin; Yan Jiao; Changying Ma; Xinwei Li; Li Dong; Jinglin Cui; Dongmei Wei; Ankur M Sharma; David L Schwartz; Weikuan Gu; Hong Chen Journal: World J Surg Oncol Date: 2020-06-17 Impact factor: 2.754
Authors: An-Sofie E Verrijssen; Wim J F Dries; Jeltsje S Cnossen; Jacqueline Theuws; Heike M U Peulen; Hetty A van den Berg; Dorien C Rijkaart; Eva L K Voogt; Inger-Karine Kolkman-Deurloo; Joost Nuyttens; Harm J T Rutten; Jacobus W A Burger; Cathryn Huibregtse Bimmel-Nagel Journal: J Contemp Brachytherapy Date: 2022-07-21