Combined modality therapy including intraoperative electron irradiation for locally recurrent colorectal cancer.

Publication Type:

Journal Article

Source:

International journal of radiation oncology, biology, physics, Volume 79, Issue 1, p.143-50 (2011)

Keywords:

Adultdigestive disease, digestive deseases Ageddigestive disease, digestive deseases Aged, 80 and overdigestive disease, digestive deseases Colonic Neoplasmsdigestive disease, digestive deseases Combined Modality Therapydigestive disease, digestive deseases Electronsdigestive disease, digestive deseases Femaledigestive disease, digestive deseases Humansdigestive disease, digestive deseases Intraoperative Caredigestive disease, digestive deseases Maledigestive disease, digestive deseases Middle Ageddigestive disease, digestive deseases Multivariate Analysisdigestive disease, digestive deseases Neoplasm Recurrence, Localdigestive disease, digestive deseases Radiation Injuriesdigestive disease, digestive deseases Radiotherapy Dosagedigestive disease, digestive deseases Rectal Neoplasmsdigestive disease, digestive deseases Survival Ratedigestive disease, digestive deseases Young Adult

Abstract:

PURPOSE: To evaluate survival, relapse patterns, and prognostic factors in patients with colorectal cancer relapse treated with curative-intent therapy, including intraoperative electron radiation therapy (IOERT).

METHODS AND MATERIALS: From April 1981 through January 2008, 607 patients with recurrent colorectal cancer received IOERT as a component of treatment. IOERT was preceded or followed by external radiation (median dose, 45.5 Gy) in 583 patients (96%). Resection was classified as R0 in 227 (37%), R1 in 224 (37%), and R2 in 156 (26%). The median IOERT dose was 15 Gy (range, 7.5-30 Gy).

RESULTS: Median overall survival was 36 months. Five- and 10-year survival rates were 30% and 16%, respectively. Survival estimates at 5 years were 46%, 27%, and 16% for R0, R1, and R2 resection, respectively. Multivariate analysis revealed that R0 resection, no prior chemotherapy, and more recent treatment (in the second half of the series) were associated with improved survival. The 3-year cumulative incidence of central, local, and distant relapse was 12%, 23%, and 49%, respectively. Central and local relapse were more common in previously irradiated patients and in those with subtotal resection. Toxicity Grade 3 or higher partially attributable to IOERT was observed in 66 patients (11%). Neuropathy was observed in 94 patients (15%) and was more common with IOERT doses exceeding 12.5 Gy.

CONCLUSIONS: Long-term survival and disease control was achievable in patients with locally recurrent colorectal cancer. Continued evaluation of curative-intent, combined-modality therapy that includes IOERT is warranted in this high-risk population.