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Intraoperative irradiation for locally recurrent colorectal cancer in previously irradiated patients

Abstract

Purpose/Objective: Little information exists in the literature on salvage treatment for patients with pelvic recurrences of colorectal cancer who have previously received high dose radiation therapy (RT). A retrospective review of such patients treated aggressively with surgical resection and intraoperative electrons (IOERT) was undertaken. Material and Methods: From 1981 through 1994, 52 previously irradiated patients with recurrent locally advanced colorectal cancer without evidence of distant metastatic disease were treated with surgical resection and intraoperative electrons (IOERT) {+-} additional external beam RT. Every attempt was made to achieve a gross total resection prior to IOERT if it could be safely accomplished. IOERT doses ranged from 1000-3000 cGy with a median of 2000 cGy. 37 patients received additional external beam radiotherapy either pre- or post-operatively with doses ranging from 500-5040 cGy (median 2520 cGy). 20 patients received 5FU {+-} leukovorin during external beam RT. Three patients received 5FU+leukovorin after completion of RT. Results: 31 males and 21 females with a median age of 55 years (range 31-73 years) were treated. 71% of patients have been followed until death or for > 2 years. The median, 2-year and 5-year actuarial overall survival is 23 months, 48% and 13%, respectively. Actuarial central disease control  More>>
Publication Date:
Jul 01, 1995
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 32; Journal Issue: 971; Other Information: Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 1995
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CHEMOTHERAPY; DELAYED RADIATION EFFECTS; ELECTRON BEAMS; IMMUNOTHERAPY; IRRADIATION PROCEDURES; LARGE INTESTINE; METASTASES; RADIATION DOSES; RADIOTHERAPY; RECTUM; SIDE EFFECTS; SURGERY
OSTI ID:
20420765
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US03R2007005170
Submitting Site:
INIS
Size:
page(s) 268
Announcement Date:

Citation Formats

Haddock, M G, Gunderson, L L, Nelson, H, Cha, S, Devine, R M, Dozois, R R, and Wolff, B G. Intraoperative irradiation for locally recurrent colorectal cancer in previously irradiated patients. United States: N. p., 1995. Web. doi:10.1016/0360-3016(95)97915-N.
Haddock, M G, Gunderson, L L, Nelson, H, Cha, S, Devine, R M, Dozois, R R, & Wolff, B G. Intraoperative irradiation for locally recurrent colorectal cancer in previously irradiated patients. United States. doi:10.1016/0360-3016(95)97915-N.
Haddock, M G, Gunderson, L L, Nelson, H, Cha, S, Devine, R M, Dozois, R R, and Wolff, B G. 1995. "Intraoperative irradiation for locally recurrent colorectal cancer in previously irradiated patients." United States. doi:10.1016/0360-3016(95)97915-N. https://www.osti.gov/servlets/purl/10.1016/0360-3016(95)97915-N.
@misc{etde_20420765,
title = {Intraoperative irradiation for locally recurrent colorectal cancer in previously irradiated patients}
author = {Haddock, M G, Gunderson, L L, Nelson, H, Cha, S, Devine, R M, Dozois, R R, and Wolff, B G}
abstractNote = {Purpose/Objective: Little information exists in the literature on salvage treatment for patients with pelvic recurrences of colorectal cancer who have previously received high dose radiation therapy (RT). A retrospective review of such patients treated aggressively with surgical resection and intraoperative electrons (IOERT) was undertaken. Material and Methods: From 1981 through 1994, 52 previously irradiated patients with recurrent locally advanced colorectal cancer without evidence of distant metastatic disease were treated with surgical resection and intraoperative electrons (IOERT) {+-} additional external beam RT. Every attempt was made to achieve a gross total resection prior to IOERT if it could be safely accomplished. IOERT doses ranged from 1000-3000 cGy with a median of 2000 cGy. 37 patients received additional external beam radiotherapy either pre- or post-operatively with doses ranging from 500-5040 cGy (median 2520 cGy). 20 patients received 5FU {+-} leukovorin during external beam RT. Three patients received 5FU+leukovorin after completion of RT. Results: 31 males and 21 females with a median age of 55 years (range 31-73 years) were treated. 71% of patients have been followed until death or for > 2 years. The median, 2-year and 5-year actuarial overall survival is 23 months, 48% and 13%, respectively. Actuarial central disease control (IOERT field) at 2 and 4 years is 72 and 57%; pelvic control at 2 and 4 years is 60 and 34%. Pelvic control rates are better in patients who received {>=} 3000 cGy external beam RT in addition to IOERT as compared to patients who received no external beam RT or < 3000 cGy, with 2 year pelvic control rates of 81% vs. 54%. 25 patients have developed distant metastases. The actuarial rate of appearance of distant metastatic disease at 2 and 4 years is 60 and 80%. Late complications attributable to IOERT include neuropathies in 13 patients (5 mild, 5 moderate, 3 severe) and narrowing or obstruction of the ureter in four patients. All but one patient with neuropathy or ureter fibrosis received IOERT doses of {>=} 2000 cGy. Other late complications include pelvic abscess in 10 patients and fistula in two patients. Conclusion: Long term pelvic control can be obtained in a substantial proportion of patients with aggressive combined modality therapy, but long term survival is poor due to the high rate of distant metastasis. Reirradiation with external beam RT in addition to IOERT appears to improve pelvic control. Strategies to improve survival in these poor risk patients may include more routine use of systemic chemotherapy or the addition of novel systemic therapies such as immunotherapy with monoclonal antibodies.}
doi = {10.1016/0360-3016(95)97915-N}
journal = {International Journal of Radiation Oncology, Biology and Physics}
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}