Intraoperative radiation therapy (IORT) in primary locally advanced and recurrent carcinoma of the rectum at a "non-dedicated" facility

Abstract

Background: Primary locally advanced and recurrent colorectal cancer still present a significant clinical challenge. Local failure rates are high in both situations. Promising results have been reported by combined radiochemotherapy, extensive surgery and intraoperative radiation therapy (IORT). Our aim was to perform IORT at a "non-dedicated" facility to improve the local tumour control rate without increasing the complication rate.

Materials and methods: From February 1997 to April 2001, 19 patients with recurrent and 4 patients with primary locally advanced colorectal cancer underwent surgery and IORT. The histology was adenocarcinoma in all cases. A complete removal of the tumour was possible in 11 patients, while an incomplete resection was achieved in 12 cases. IORT doses ranged from 10-20 Gy and electron energies from 6-14 MeV were used. Fourteen patients had pre- or postoperative external beam radiochemotherapy.

Results: After a median follow-up of 27 months, 18 patients (78%) are alive. Five of these patients have a progressive disease. Five patients (22%) died in progressive disease. The amount of residual cancer remaining after surgery is an important factor regarding treatment outcome. Complications were observed in 8 patients (35%). These complications were severe only in 4 patients (17%). Fifteen patients (65%) have had no complications at all. No perioperative or postoperative deaths were seen.

Conclusion: IORT combined with radical surgery, external beam radiotherapy and systemic chemotherapy is feasible at a "non-dedicated" facility without increasing the postoperative complications. A complete resection is the most important factor for a favourable outcome.