Intensification of Local Therapy With High Dose Rate, Intraoperative Radiation Therapy (HDR-IORT) and Extended Resection for Locally Advanced and Recurrent Colorectal Cancer
Details
Publication Year 2023-09,Volume 22,Issue #3,Page 257-266
Journal Title
Clinical Colorectal Cancer
Publication Type
Research article
Abstract
BACKGROUND: We report our long-term experience with high dose rate intraoperative radiotherapy (HDR-IORT) in a single, quaternary institution. PATIENTS/METHODS: From 2004 to 2020, 60 HDR-IORT procedures for locally advanced colorectal cancer (LACC) and 81 for locally recurrent colorectal cancer (LRCC) were done in our institution. Preoperative radiotherapy was done prior to majority of the resections (89%, 125/141). Sixty-nine percent (58/84) of the resections involving pelvic exenterations had >3 en bloc organs resected. HDR-IORT was delivered using a Freiburg applicator. A single 10 Gy fraction was delivered. Margin status was R0 and R1 in 54% (76/141) and 46% (65/141) of the resections, respectively. RESULTS: With a median follow-up time of 4 years, 3-, 5-, and 7- year, overall survival (OS) rates were 84%, 58%, and 58% for LACC and 68%, 41%, and 37% for LRCC, respectively. Local progression-free survival (LPFS) rates were 97%, 93%, and 93% for LACC and 80%, 80%, 80% for LRCC, respectively. For the LRCC group, an R1 resection was associated with worse OS, LPFS, and progression-free survival (PFS), preoperative EBRT was associated with improved LPFS and PFS, and >/=2 years disease-free interval was associated with improved PFS. The most common severe adverse events were postoperative abscess (n = 25) and bowel obstruction (n = 11). There were 68 grade 3 to 4 and no grade 5 adverse events. CONCLUSIONS: Favorable OS and LPFS can be achieved for LACC and LRCC with intensive local therapy. In patients with risk factors for poorer outcomes, optimization of EBRT and IORT, surgical resection, and systemic therapy are required.
Publisher
Elsevier
Keywords
Humans; *Brachytherapy/adverse effects; Neoplasm Recurrence, Local/epidemiology/surgery/drug therapy; *Colorectal Neoplasms/radiotherapy/surgery; Combined Modality Therapy; Intraoperative Care; Brachytherapy; Colon cancer; Exenteration; R1 resection; Rectal cancer
Department(s)
Radiation Oncology; Biostatistics and Clinical Trials; Radiation Therapy; Surgical Oncology
PubMed ID
37100642
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Refer to copyright notice on published article.


Creation Date: 2023-11-14 12:57:56
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