Abstract
PURPOSE: We retrospectively analyzed prognostic factors for surgical resection and intraoperative radiation therapy to identify indicators for this treatment strategy. METHODS: Thirty-nine consecutive patients with locally recurrent colorectal cancer who underwent surgical resection with intraoperative radiation therapy from January 1, 1987, to June 30, 1999, were analyzed. The mean electron energy was 10.5 MeV and the mean intraoperative radiation dose was 22.6 Gy. Kaplan-Meier survival estimates were obtained for the 37 patients who recovered postoperatively. Prognostic factors were analyzed univariately by log-rank test and multivariately by Cox’s proportional hazards model. RESULTS: Three-year cumulative survival was 44 percent (standard error = 11) for 26 patients free of unresectable distant metastasis who underwent surgical resection and intraoperative radiation therapy for pelvic recurrence of colorectal cancer, but none of the 11 patients with unresectable distant metastasis survived 3 years. Preoperative prognostic factors which were significant on univariate and multivariate analysis were unresectable distant metastasis (P = 0.001) and elevated preoperative serum CA 19–9 (P = 0.02). Patients with synchronous resection of local recurrence and distant metastasis had a significant survival advantage over those without resection of metastases (P = 0.02). Univariate analysis in a subgroup of 26 patients without unresectable distant metastasis revealed pain (P = 0.0003) to be a useful preoperative prognostic indicator, whereas tumor fixation (P = 0.01) and amount of residual tumor after surgical resection (P = 0.01) were significant intraoperative and postoperative factors, respectively. Fluorouracil-based postoperative systemic chemotherapy produced a significant survival benefit (P = 0.04). CONCLUSIONS: Patients with unresectable distant metastasis are not suitable candidates for surgical resection and intraoperative radiation therapy, whereas those with resectable metastasis are potential candidates. Intraoperative radiation therapy may be less useful for patients with pain, elevated preoperative CA19–9, fixed tumors, or gross residual tumor after surgical resection. Multimodal treatment strategies combining preoperative and/or postoperative external beam radiation therapy and intraoperative radiation therapy with fluorouracil-based systemic chemotherapy are recommended for patients with these indicators.
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References
CG Willett PC Shellito JE Tepper R Eliseo K Convery WC Wood (1991) ArticleTitleIntraoperative electron beam radiation therapy for recurrent locally advanced rectal or rectosigmoid carcinoma Cancer 57 1504–1508
K Suzuki LL Gunderson RM Devine et al. (1995) ArticleTitleIntraoperative irradiation after palliative surgery for locally recurrent rectal cancer Cancer 75 939–952
HJ Wallace SuffixIII CG Willett PC Shellito JJ Coen HC Hoover SuffixJr (1995) ArticleTitleIntraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer J Surg Oncol 60 122–127
LL Gunderson H Nelson JA Martenson et al. (1996) ArticleTitleIntraoperative electron and external beam irradiation with or without 5-fluorouracil and maximum surgical resection for previously unirradiated locally recurrent colorectal cancer Dis Colon Rectum 39 1379–1395
Y Hashiguchi T Sekine H Sakamoto et al. (1999) ArticleTitleIntraoperative irradiation after surgery for locally recurrent rectal cancer Dis Colon Rectum 42 886–895
S Magrini H Nelson LL Gunderson FH Sim (1996) ArticleTitleSacropelvic resection and intraoperative electron irradiation in the management of recurrent anorectal cancer Dis Colon Rectum 39 1–9
RN Goes RW Beart SuffixJr AJ Simons LL Gunderson G Grado O Streeter (1997) ArticleTitleUse of brachytherapy in management of locally recurrent rectal cancer Dis Colon Rectum 40 1177–1179
G Gagliardi PR Hawley MJ Hershman SJ Arnott (1995) ArticleTitlePrognostic factors in surgery for local recurrence of rectal cancer Br J Surg 82 1401–1405
JR Delpero B Pol YP Letreut et al. (1998) ArticleTitleSurgical resection of locally recurrent colorectal adenocarcinoma Br J Surg 85 372–376
PS Turk HJ Wanebo (1993) ArticleTitleResults of surgical treatment of nonhepatic recurrence of colorectal carcinoma Cancer 71 4267–4277
GH Ballantyne J Quin (1993) ArticleTitleSurgical treatment of liver metastases in patients with colorectal cancer Cancer 71 4252–4266
HC Polk SuffixJr JS Spratt SuffixJr (1979) ArticleTitleThe results of treatment of perineal recurrence of cancer of the rectum Cancer 43 952–955
R Schiessel M Wunderlich F Herbst (1986) ArticleTitleLocal recurrence of colorectal cancer Br J Surg 73 342–344
LL Gunderson JK Martin RW Beart SuffixJr et al. (1988) ArticleTitleIntraoperative and external beam irradiation for locally advanced colorectal cancer Ann Surg 207 52–60
S Maetani T Nishikawa Y Iijima et al. (1992) ArticleTitleExtensive en bloc resection of regionally recurrent carcinoma of the rectum Cancer 69 2876–2883
K Suzuki RR Dozois RM Devine et al. (1996) ArticleTitleCurative reoperations for locally recurrent rectal cancer Dis Colon Rectum 39 730–736
X Filella R Molina JJ Grau et al. (1992) ArticleTitlePrognostic value of CA 19.9 levels in colorectal cancer Ann Surg 216 55–59
M Diez FJ Cerdan M Pollan et al. (1994) ArticleTitlePrognostic significance of preoperative serum CA 19.9 assay in patients with colorectal carcinoma Anticancer Res 14 2819–2825
T Nakayama M Watanabe T Teramoto M Kitajima (1997) ArticleTitleCA199 as a predictor of recurrence in patients with colorectal cancer J Surg Oncol 66 238–243
N Petrelli L Herrera Y Rustan et al. (1987) ArticleTitleA prospective randomized trial of 5-fluorouracil vs 5-fluorouracil and high-dose leucovorin vs 5-fluorouracil and methotrexate in previously untreated patients with advanced colorectal carcinoma J Clin Oncol 5 1559–1565
InstitutionalAuthorNameInternational Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators (1995) ArticleTitleEfficacy of adjuvant fluorouracil and folinic acid in colon cancer Lancet 345 939–944
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Hashiguchi, Y., Sekine, T., Kato, S. et al. Indicators for Surgical Resection and Intraoperative Radiation Therapy for Pelvic Recurrence of Colorectal Cancer. Dis Colon Rectum 46, 31–39 (2003). https://doi.org/10.1007/s10350-004-6493-5
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DOI: https://doi.org/10.1007/s10350-004-6493-5