TY - JOUR
T1 - Value of intraoperative radiotherapy in locally advanced rectal cancer
AU - Ferenschild, Floris T.J.
AU - Vermaas, Maarten
AU - Nuyttens, Joost J.M.E.
AU - Graveland, Wilfried J.
AU - Marinelli, Andreas W.K.S.
AU - Van Der Sijp, Joost R.
AU - Wiggers, Theo
AU - Verhoef, Cornelis
AU - Eggermont, Alexander M.M.
AU - De Wilt, Johannes H.W.
PY - 2006/9
Y1 - 2006/9
N2 - PURPOSE: This study was designed to analyze the results of a multimodality treatment using preoperative radiotherapy, followed by surgery and intraoperative radiotherapy in patients with primary locally advanced rectal cancer. METHODS: Between 1987 and 2002, 123 patients with initial unresectable and locally advanced rectal cancer were identified in our prospective database, containing patient characteristics, radiotherapy plans, operation notes, histopathologic reports, and follow-up details. An evaluation of prognostic factors for local recurrence, distant metastases, and overall survival was performed. RESULTS: All patients were treated preoperatively with a median dose of 50 Gy radiotherapy. Surgery was performed six to ten weeks after radiotherapy. Twenty-seven patients were treated with intraoperative radiotherapy because margins were incomplete or ≤2 mm. Postoperative mortality was 2 percent. The median follow-up of all patients was 25.1 months. The overall five-year local control was 65 percent and the overall five-year survival was 50 percent. Positive lymph nodes and incomplete resections negatively influenced local control and overall survival. Intraoperative radiotherapy improved five-year local control (58 vs. 0 percent, P = 0.016) and overall survival (38 vs. 0 percent, P = 0.026) for patients with R1/2 resections. CONCLUSIONS: The presented multimodality treatment is feasible with an acceptable mortality and a five-year overall survival of 50 percent. Addition of intraoperative radiotherapy for patients with a narrow or microscopic incomplete resection seems to overrule the unfavorable prognostic histologic finding.
AB - PURPOSE: This study was designed to analyze the results of a multimodality treatment using preoperative radiotherapy, followed by surgery and intraoperative radiotherapy in patients with primary locally advanced rectal cancer. METHODS: Between 1987 and 2002, 123 patients with initial unresectable and locally advanced rectal cancer were identified in our prospective database, containing patient characteristics, radiotherapy plans, operation notes, histopathologic reports, and follow-up details. An evaluation of prognostic factors for local recurrence, distant metastases, and overall survival was performed. RESULTS: All patients were treated preoperatively with a median dose of 50 Gy radiotherapy. Surgery was performed six to ten weeks after radiotherapy. Twenty-seven patients were treated with intraoperative radiotherapy because margins were incomplete or ≤2 mm. Postoperative mortality was 2 percent. The median follow-up of all patients was 25.1 months. The overall five-year local control was 65 percent and the overall five-year survival was 50 percent. Positive lymph nodes and incomplete resections negatively influenced local control and overall survival. Intraoperative radiotherapy improved five-year local control (58 vs. 0 percent, P = 0.016) and overall survival (38 vs. 0 percent, P = 0.026) for patients with R1/2 resections. CONCLUSIONS: The presented multimodality treatment is feasible with an acceptable mortality and a five-year overall survival of 50 percent. Addition of intraoperative radiotherapy for patients with a narrow or microscopic incomplete resection seems to overrule the unfavorable prognostic histologic finding.
KW - Intraoperative radiotherapy
KW - Primary locally advanced
KW - Radiotherapy
KW - Rectal cancer
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=33748753319&partnerID=8YFLogxK
U2 - 10.1007/s10350-006-0651-x
DO - 10.1007/s10350-006-0651-x
M3 - Article
C2 - 16912909
AN - SCOPUS:33748753319
SN - 0012-3706
VL - 49
SP - 1257
EP - 1265
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
IS - 9
ER -