TY - JOUR
T1 - Intraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer
AU - Lindel, Katja
AU - Willett, Christopher G.
AU - Shellito, Paul C.
AU - Ott, Mark J.
AU - Clark, Jeffrey
AU - Grossbard, Michael
AU - Ryan, David
AU - Ancukiewicz, Marek
PY - 2001/1/20
Y1 - 2001/1/20
N2 - Background and purpose: To update and summarize the experience at the Massachusetts General Hospital of a treatment program of high-dose preoperative irradiation, surgical re-resection, and intraoperative radiation therapy (IORT) as a salvage treatment for patients with recurrent rectal or rectosigmoid carcinoma. Patients and methods: From June 1978 to February 1997, the records of 69 patients with locally recurrent rectal carcinomas or rectosigmoid carcinomas without metastases referred for consideration of IORT were reviewed. Forty-nine patients received IORT and local control and disease-free survival curves were calculated using the actuarial method of Kaplan-Meier. Results: The 5-year overall survival, local control and disease-free survival rates of 49 patients receiving IORT were 27, 35, and 20%, respectively. Thirty-four patients who underwent a macroscopic complete resection had a significantly better 5-year overall survival than the remaining 15 patients with gross residual disease (33 vs. 13%, P=0.05, log rank). For those patients, local control and disease-free survival rates were 46 and 27%, respectively. Patients with a microscopic complete resection had a superior 5-year overall survival than partially resected patients (40 vs. 14%, P = 0.0001, log rank). Chemotherapy had no significant influence on overall or disease-free survival. Conclusion: The current analysis shows the importance of a microscopic complete resection in a multi-modality approach with IORT for survival and local control. Salvage is rare for patients undergoing subtotal resection.
AB - Background and purpose: To update and summarize the experience at the Massachusetts General Hospital of a treatment program of high-dose preoperative irradiation, surgical re-resection, and intraoperative radiation therapy (IORT) as a salvage treatment for patients with recurrent rectal or rectosigmoid carcinoma. Patients and methods: From June 1978 to February 1997, the records of 69 patients with locally recurrent rectal carcinomas or rectosigmoid carcinomas without metastases referred for consideration of IORT were reviewed. Forty-nine patients received IORT and local control and disease-free survival curves were calculated using the actuarial method of Kaplan-Meier. Results: The 5-year overall survival, local control and disease-free survival rates of 49 patients receiving IORT were 27, 35, and 20%, respectively. Thirty-four patients who underwent a macroscopic complete resection had a significantly better 5-year overall survival than the remaining 15 patients with gross residual disease (33 vs. 13%, P=0.05, log rank). For those patients, local control and disease-free survival rates were 46 and 27%, respectively. Patients with a microscopic complete resection had a superior 5-year overall survival than partially resected patients (40 vs. 14%, P = 0.0001, log rank). Chemotherapy had no significant influence on overall or disease-free survival. Conclusion: The current analysis shows the importance of a microscopic complete resection in a multi-modality approach with IORT for survival and local control. Salvage is rare for patients undergoing subtotal resection.
KW - Intraoperative radiation therapy
KW - Local failure
KW - Recurrent rectal carcinoma
KW - Salvage
UR - http://www.scopus.com/inward/record.url?scp=0035915780&partnerID=8YFLogxK
U2 - 10.1016/S0167-8140(00)00309-1
DO - 10.1016/S0167-8140(00)00309-1
M3 - Article
C2 - 11165686
AN - SCOPUS:0035915780
SN - 0167-8140
VL - 58
SP - 83
EP - 87
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 1
ER -