Intraoperative radiation therapy for locally advanced primary and recurrent colorectal cancer: Ten‐year institutional experience

Hyngstrom, John; Tzeng, Ching Wei D.; Beddar, Sam; Das, Prajnan; Krishnan, Sunil; Delclos, Marc E.; Crane, Christopher H.; Chang, George J.; You, Yau‐Tong; Feig, Barry W.; Skibber, John M.; Rodrı́guez-Bigas, Miguel A.

doi:10.1002/jso.23570

Cited by 50 publications

(28 citation statements)

References 31 publications

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“…Before 2001, IORT was typically administered using a linear accelerator delivering 6–15 meV electrons, with dose of 10–20 Gy, prescribed to the 90 per cent isodose line. From 2001, IORT was administered using high‐dose rate iridium‐192 brachytherapy using a Harrison–Anderson–Mick applicator, with a dose of 10–15 Gy at 1 cm from the radiation source. Postoperative adjuvant chemotherapy was used selectively depending on previous treatments, surgical pathology and the patient's performance status after surgery.…”

Section: Methodsmentioning

confidence: 99%

Impact of multimodal therapy in locally recurrent rectal cancer

You

Skibber

et al. 2016

British Journal of Surgery

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Background The practice of salvaging recurrent rectal cancer has evolved. Among patients with locally-recurrent disease, we aimed to define their evolving salvage potential over time, and to identify durable determinants of long-term success. Methods In consecutive patients undergoing curative-intent multimodality salvage between 1988–2012, predictors of long-term survival were defined by Cox regression analysis and compared over time. Re-recurrence and subsequent treatments were evaluated. Results After multi-disciplinary evaluation of 229 patients, curative-intent salvage therapy included preoperative chemotherapy and/or radiation (74%, with 41% undergoing repeat pelvic irradiation), surgical salvage resection with/without intraoperative radiation (83 patients, 36%), followed by postoperative adjuvant chemotherapy (87, 38%). Curative-intent resection involved multi-visceral resection in 47% and bone resection in 30%, leading to a R0 resection rate of 81%. After a median follow-up of 56 months, the 5-year overall survival was 49.8% in 2005–2012, markedly increased from 31.5% in 1988–1997 (p=0.044). Long-term success was associated with R0 resection (p = 0.017) and lack of secondary failure (p=0.003). 125 (55%) patients had re-recurrence at 19 months (median). Repeat operative rescue was feasible in 44% of the patients with local-only and 20% of the patients with distant re-recurrence, and resulted in a median survival of 20 months after re-recurrence. Conclusions The long-term salvage potential for recurrent rectal cancer has significantly improved with time, when an individualized treatment algorithm of multimodality treatments and surgical salvage is considered. Durable predictors of long-term success were achieving an R0 resection at salvage operation, avoidance of secondary failure, and feasibility of repeat rescue after re-recurrence.

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Section: Methodsmentioning

confidence: 99%

Impact of multimodal therapy in locally recurrent rectal cancer

You

Skibber

et al. 2016

British Journal of Surgery

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“…Wiig ve ark (22) yapmış olduğu çalışmada R0 rezeksiyonda İORT uygulanan ve uygulanmayan hastalar karşılaştırıldı-ğında sağkalım arasında fark saptanmamasına rağmen lokal kontrolde İORT'in etkili olduğu bildirilmiştir. Lokal ileri ve nüks kolorektal kanser nedeniyle cerrahi+İORT uygulanan hastalarda R0 ve R1 rezeksiyon arasında lokal nükste fark saptanmamıştır (23). R2 rezeksiyonun sonuçların kötü olarak beklenmesine rağmen, eksternal RT'ye İORT eklendiğinde sağkalım ve lokal nüksün bu olgularda iyileştiği gösterilmiştir (24).…”

Section: Discussionunclassified

Nüks Rektum Kanserinde İntraoperatif Radyoterapi

Bilgin¹,

Aytaç²,

Bayraktar³

et al. 2020

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ÖzetGiriş: Lokal ileri ve nüks rektum kanserinde multimodal tedavi seçeneklerden biri olan intraoperatif radyoterapi (İORT), lokal kontrolü sağlamak için tercih edilebilir. Bu çalışmada nüks rektum kanseri nedeniyle radikal cerrahi ve intraoperatif radyoterapi uyguladığımız hastalar üzerindeki deneyimimizi sunmayı amaçladık. Metod INTRAoPERATIvE RAdIATIoN THERAPy FoR REcuRRENT REcTAl cANcERABSTRAcT Introduction: As one of the multimodal treatment options available in locally advanced or recurrent rectal cancer, intraoperative radiotherapy (IORT) may be a preferred option to achieve local control. In this study, we aim to report on our experience with those recurrent rectal cancer cases which were treated with radical surgery and intraoperative radiotherapy.

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“…) from 100 consecutive patients treated with IORT at MD Anderson. R0 resection was achieved for 54% of the patients and 46% were resected with R1, none were R2 . Most of these patients had recurrent disease and most required multivisceral resection.…”

Section: So What Do We Do At MD Anderson?mentioning

confidence: 99%

“…There was no difference in post-IORT overall survival in patients with positive (R1) vs negative (R0) microscopic margins[9]. (Reprinted from Hyngstrom et al[9]. Copyright (2014), with permission from John Wiley and Sons.…”

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confidence: 99%

Session 3: Intra‐operative radiotherapy – creating new surgical boundaries

et al. 2018

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In patients with advanced and recurrent colorectal cancer, surgical resection with clear margins is the greatest challenge and is limited by known anatomical constraints. Preoperative or intra-operative assessment of the limits of surgical dissection may help to explore the possibility of improving resectability through either targeted external beam radiotherapy or intra-operative radiotherapy. Professor Chang reviews the evidence base and potential advantages and disadvantages of this approach, whilst the expert panel agree a consensus on the evidence for assessment and therapy of such patients.

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Intraoperative radiation therapy for locally advanced primary and recurrent colorectal cancer: Ten‐year institutional experience

Abstract: For patients with primary or recurrent locally advanced CRC, treatment with radical surgery and IORT achieved excellent LC outcomes irrespective of microscopic margin status. IORT may be indicated for tumors suspected to have close or positive microscopic margins.

Cited by 50 publications

References 31 publications

Impact of multimodal therapy in locally recurrent rectal cancer

Impact of multimodal therapy in locally recurrent rectal cancer

Nüks Rektum Kanserinde İntraoperatif Radyoterapi

Session 3: Intra‐operative radiotherapy – creating new surgical boundaries

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