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. 2023 Jun 2;18(1):94.
doi: 10.1186/s13014-023-02289-2.

Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignancies

Jacob Hall  1 , Jessica Wilson  2 , John Shumway  3 , Ted K Yanagihara  3 , Joel Tepper  3 , Benjamin Calvo  4 , Andrew Z Wang  5 , Kevin Pearlstein  3 , Kyle Wang  6 , Hong Jin Kim  7
Affiliations

Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignancies

Jacob Hall et al. Radiat Oncol. .

Abstract

Background: Para-aortic lymph node (PALN) metastases from primary pelvic malignancies are often treated with resection, but recurrence is common. We report toxicity and oncologic outcomes for patients with PALN metastases from gastrointestinal and gynecologic malignancies treated with resection and intraoperative electron radiotherapy (IORT).

Methods: We retrospectively identified patients with recurrent PALN metastases who underwent resection with IORT. All patients were included in the local recurrence (LR) and toxicity analyses. Only patients with primary colorectal tumors were included in the survival analysis.

Results: There were 26 patients with a median follow up of 10.4 months. The rate of para-aortic local control (LC) was 77% (20/26 patients) and the rate of any cancer recurrence was 58% (15/26 patients). Median time from surgery and IORT to any recurrence was 7 months. The LR rate for those with positive/close margins was 58% (7/12 patients) versus 7% (1/14 patients) for those with negative margins (p = 0.009). 15% (4/26 patients) developed surgical wound and/or infectious complications, 8% (2/26 patients) developed lower extremity edema, 8% (2/26 patients) experienced diarrhea, and 19% (5/26 patients) developed an acute kidney injury. There were no reported nerve injuries, bowel perforations, or bowel obstructions. For patients with primary colorectal tumors (n = 19), the median survival (OS) was 23 months.

Conclusions: We report favorable LC and acceptable toxicity for patients receiving surgical resection and IORT for a population that has historically poor outcomes. Our data show disease control rates similar to literature comparisons for patients with strong risk factors for LR, such as positive/close margins.

Keywords: Colorectal metastases; Intraoperative radiotherapy; Para-aortic recurrence.

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Conflict of interest statement

Certain authors (denoted on the Title page) are employed by the University of North Carolina. There are otherwise no conflicts of interest to disclose.

Certain authors (listed above) are employed by the University of North Carolina. There are otherwise no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Local progression free rate (LPFR)
Fig. 2
Fig. 2
Overall survival for patients with colorectal primary tumors
See this image and copyright information in PMC

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