Fabian A Holman1, Michael G Haddock2, Leonard L Gunderson3, Miranda Kusters4, Grard A P Nieuwenhuijzen, Hetty A van den Berg, Heidi Nelson5, Harm J T Rutten6. 1. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. 2. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA. 3. Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA. 4. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; 5. Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA. 6. ; GROW: School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands.
Abstract
BACKGROUND: The aim of this study is to analyse the pooled results of intraoperative electron beam radiotherapy (IOERT) containing multimodality treatment of locally advanced T4 rectal cancer, initially unresectable for cure, from the Mayo Clinic, Rochester, USA (MCR) and Catharina Hospital, Eindhoven, The Netherlands (CHE), both major referral centers for locally advanced rectal cancer. A rectal tumor is called locally unresectable for cure if after full clinical work-up infiltration into the surrounding structures or organs has been demonstrated, which would result in positive surgical margins if resection was the initial component of treatment. This was the reason to refer these patients to the IOERT program of one of the centers. METHODS: In the period from 1981 to 2010, 417 patients with locally unresectable T4 rectal carcinomas at initial presentation were treated with multimodality treatment including IOERT at either one of the two centres. The preferred treatment approach was preoperative (chemo) radiation and intended radical surgery combined with IOERT. Risk factors for local recurrence (LR), cancer specific survival, disease free survival and distant metastases (DM) were assessed. RESULTS: A total of 306 patients (73%) underwent a R0 resection. LRs and metastases occurred more frequently after an R1-2 resection (P<0.001 and P<0.001 respectively). Preoperative chemoradiation (preop CRT) was associated with a higher probability of having a R0 resection. Waiting time after preoperative treatment was inversely related with the chance of developing a LR, especially after R+ resection. In 16% of all cases a LR developed. Five-year disease free survival and overall survival (OS) were 55% and 56% respectively. CONCLUSIONS: An acceptable survival can be achieved in treatment of patients with initially unresectable T4 rectal cancer with combined modality therapy that includes preop CRT and IOERT. Completeness of the resection is the most important predictive and prognostic factor in the treatment of T4 rectal cancer for all outcome parameters. IOERT can reduce the LR rate effectively, especially in R+ resected patients.
BACKGROUND: The aim of this study is to analyse the pooled results of intraoperative electron beam radiotherapy (IOERT) containing multimodality treatment of locally advanced T4 rectal cancer, initially unresectable for cure, from the Mayo Clinic, Rochester, USA (MCR) and Catharina Hospital, Eindhoven, The Netherlands (CHE), both major referral centers for locally advanced rectal cancer. A rectal tumor is called locally unresectable for cure if after full clinical work-up infiltration into the surrounding structures or organs has been demonstrated, which would result in positive surgical margins if resection was the initial component of treatment. This was the reason to refer these patients to the IOERT program of one of the centers. METHODS: In the period from 1981 to 2010, 417 patients with locally unresectable T4 rectal carcinomas at initial presentation were treated with multimodality treatment including IOERT at either one of the two centres. The preferred treatment approach was preoperative (chemo) radiation and intended radical surgery combined with IOERT. Risk factors for local recurrence (LR), cancer specific survival, disease free survival and distant metastases (DM) were assessed. RESULTS: A total of 306 patients (73%) underwent a R0 resection. LRs and metastases occurred more frequently after an R1-2 resection (P<0.001 and P<0.001 respectively). Preoperative chemoradiation (preop CRT) was associated with a higher probability of having a R0 resection. Waiting time after preoperative treatment was inversely related with the chance of developing a LR, especially after R+ resection. In 16% of all cases a LR developed. Five-year disease free survival and overall survival (OS) were 55% and 56% respectively. CONCLUSIONS: An acceptable survival can be achieved in treatment of patients with initially unresectable T4 rectal cancer with combined modality therapy that includes preop CRT and IOERT. Completeness of the resection is the most important predictive and prognostic factor in the treatment of T4 rectal cancer for all outcome parameters. IOERT can reduce the LR rate effectively, especially in R+ resected patients.
Entities:
Keywords:
T4 rectal cancer; intraoperative irradiation; pooled results; re-irradiation
Authors: Stephanie Terezakis; Lisa Morikawa; Abraham Wu; Zhigang Zhang; Weiji Shi; Martin R Weiser; Philip B Paty; Jose Guillem; Larissa Temple; Garrett M Nash; Michael J Zelefsky; Karyn A Goodman Journal: Ann Surg Oncol Date: 2015-01-29 Impact factor: 5.344
Authors: David E Stein; Najjia N Mahmoud; Pramila Rani Anné; Deborah G Rose; Gerald A Isenberg; Scott D Goldstein; Edith Mitchell; Robert D Fry Journal: Dis Colon Rectum Date: 2003-04 Impact factor: 4.585
Authors: Luiz Felipe de Campos-Lobato; Daniel P Geisler; Andre da Luz Moreira; Luca Stocchi; David Dietz; Matthew F Kalady Journal: J Gastrointest Surg Date: 2010-12-08 Impact factor: 3.452
Authors: Matthew F Kalady; Luiz Felipe de Campos-Lobato; Luca Stocchi; Daniel P Geisler; David Dietz; Ian C Lavery; Victor W Fazio Journal: Ann Surg Date: 2009-10 Impact factor: 12.969
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: C M Dolinsky; N N Mahmoud; R Mick; W Sun; R W Whittington; L J Solin; D G Haller; B J Giantonio; P J O'Dwyer; E F Rosato; R D Fry; J M Metz Journal: J Surg Oncol Date: 2007-09-01 Impact factor: 3.454
Authors: Felipe Ángel Calvo Manuel; Javier Serrano; Claudio Solé; Mauricio Cambeiro; Jacobo Palma; Javier Aristu; Jose Luis Garcia-Sabrido; Miguel Angel Cuesta; Emilio Del Valle; Fernando Lapuente; Bernardino Miñana; Miguel Ángel Morcillo; Jose Manuel Asencio; Javier Pascau Journal: Clin Transl Oncol Date: 2022-09-28 Impact factor: 3.340
Authors: Katharina Joechle; Eleni Gkika; Anca-Ligia Grosu; Ulrich T Hopt; Hannes P Neeff; Stefan Fichtner-Feigl; Sven A Lang Journal: Chirurg Date: 2020-11 Impact factor: 0.955
Authors: K van den Berg; D P Schaap; E L K Voogt; T E Buffart; H M W Verheul; J W B de Groot; C Verhoef; J Melenhorst; J M L Roodhart; J H W de Wilt; H L van Westreenen; A G J Aalbers; M van 't Veer; C A M Marijnen; J Vincent; L H J Simkens; N A J B Peters; M Berbée; I M Werter; P Snaebjornsson; H M U Peulen; I G van Lijnschoten; M J Roef; G A P Nieuwenhuijzen; J G Bloemen; J M W E Willems; G J M Creemers; J Nederend; H J T Rutten; J W A Burger Journal: BMC Cancer Date: 2022-09-06 Impact factor: 4.638