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Title: Patterns of Failure and Local Control After Intraoperative Electron Boost Radiotherapy to the Presacral Space in Combination with Total Mesorectal Excision in Patients with Locally Advanced Rectal Cancer

Abstract

Purpose: To evaluate local control and patterns of failure in patients treated with intraoperative electron beam radiotherapy (IOERT) after total mesorectal excision (TME), to appraise the effectiveness of intraoperative target definition. Methods and Materials: We analyzed the outcome of 243 patients with rectal cancer treated with IOERT (median dose, 10 Gy) after TME. Eighty-eight patients received neoadjuvant and 122 patients adjuvant external beam radiotherapy (EBRT) (median dose, 41.4 Gy), and in 88% simultaneous chemotherapy was applied. Median follow-up was 59 months. Results: Local failure was observed in 17 patients (7%), resulting in a 5-year local control rate of 92%. Only complete resection and absence of nodal involvement correlated positively with local control. Considering IOERT fields, seven infield recurrences were seen in the presacral space, resulting in a 5-year local control rate of 97%. The remaining local relapses were located as follows: retrovesical/retroprostatic (5), anastomotic site (2), promontorium (1), ileocecal (1), and perineal (1). Conclusion: Intraoperative electron beam radiotherapy as part of a multimodal treatment approach including TME is a highly effective regimen to prevent local failure. The presacral space remains the site of highest risk for local failure, but IOERT can decrease the percentage of relapses in this area.

Authors:
 [1];  [1];  [1];  [1];  [1];  [1];  [1];  [1];  [2];  [1];  [1];  [2];  [1];  [3]
  1. Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany)
  2. Department of Surgery, University of Heidelberg, Heidelberg (Germany)
  3. Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany). E-mail: robert_krempien@med.uni-heidelberg.de
Publication Date:
OSTI Identifier:
20951581
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2006.11.039; PII: S0360-3016(06)03490-0; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CHEMOTHERAPY; ELECTRON BEAMS; FAILURES; HEALTH HAZARDS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; RECTUM

Citation Formats

Roeder, Falk, Treiber, Martina, Oertel, Susanne, Dinkel, Julien, Timke, Carmen, Funk, Angela, Garcia-Huttenlocher, Helena, Bischof, Marc, Weitz, Juergen, Harms, Wolfgang, Hensley, Frank W., Buchler, Markus W., Debus, Juergen, and Krempien, Robert. Patterns of Failure and Local Control After Intraoperative Electron Boost Radiotherapy to the Presacral Space in Combination with Total Mesorectal Excision in Patients with Locally Advanced Rectal Cancer. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.11.039.
Roeder, Falk, Treiber, Martina, Oertel, Susanne, Dinkel, Julien, Timke, Carmen, Funk, Angela, Garcia-Huttenlocher, Helena, Bischof, Marc, Weitz, Juergen, Harms, Wolfgang, Hensley, Frank W., Buchler, Markus W., Debus, Juergen, & Krempien, Robert. Patterns of Failure and Local Control After Intraoperative Electron Boost Radiotherapy to the Presacral Space in Combination with Total Mesorectal Excision in Patients with Locally Advanced Rectal Cancer. United States. doi:10.1016/j.ijrobp.2006.11.039.
Roeder, Falk, Treiber, Martina, Oertel, Susanne, Dinkel, Julien, Timke, Carmen, Funk, Angela, Garcia-Huttenlocher, Helena, Bischof, Marc, Weitz, Juergen, Harms, Wolfgang, Hensley, Frank W., Buchler, Markus W., Debus, Juergen, and Krempien, Robert. Sun . "Patterns of Failure and Local Control After Intraoperative Electron Boost Radiotherapy to the Presacral Space in Combination with Total Mesorectal Excision in Patients with Locally Advanced Rectal Cancer". United States. doi:10.1016/j.ijrobp.2006.11.039.
@article{osti_20951581,
title = {Patterns of Failure and Local Control After Intraoperative Electron Boost Radiotherapy to the Presacral Space in Combination with Total Mesorectal Excision in Patients with Locally Advanced Rectal Cancer},
author = {Roeder, Falk and Treiber, Martina and Oertel, Susanne and Dinkel, Julien and Timke, Carmen and Funk, Angela and Garcia-Huttenlocher, Helena and Bischof, Marc and Weitz, Juergen and Harms, Wolfgang and Hensley, Frank W. and Buchler, Markus W. and Debus, Juergen and Krempien, Robert},
abstractNote = {Purpose: To evaluate local control and patterns of failure in patients treated with intraoperative electron beam radiotherapy (IOERT) after total mesorectal excision (TME), to appraise the effectiveness of intraoperative target definition. Methods and Materials: We analyzed the outcome of 243 patients with rectal cancer treated with IOERT (median dose, 10 Gy) after TME. Eighty-eight patients received neoadjuvant and 122 patients adjuvant external beam radiotherapy (EBRT) (median dose, 41.4 Gy), and in 88% simultaneous chemotherapy was applied. Median follow-up was 59 months. Results: Local failure was observed in 17 patients (7%), resulting in a 5-year local control rate of 92%. Only complete resection and absence of nodal involvement correlated positively with local control. Considering IOERT fields, seven infield recurrences were seen in the presacral space, resulting in a 5-year local control rate of 97%. The remaining local relapses were located as follows: retrovesical/retroprostatic (5), anastomotic site (2), promontorium (1), ileocecal (1), and perineal (1). Conclusion: Intraoperative electron beam radiotherapy as part of a multimodal treatment approach including TME is a highly effective regimen to prevent local failure. The presacral space remains the site of highest risk for local failure, but IOERT can decrease the percentage of relapses in this area.},
doi = {10.1016/j.ijrobp.2006.11.039},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 67,
place = {United States},
year = {Sun Apr 01 00:00:00 EDT 2007},
month = {Sun Apr 01 00:00:00 EDT 2007}
}