Document Detail


Intraoperative pelvic brachytherapy for treatment of locally advanced or recurrent colorectal cancer.
MedLine Citation:
PMID:  22986843     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The aim of this study was to evaluate the efficacy and morbidity of intraoperative radiation therapy (IORT) for advanced colorectal cancer.
METHODS: All patients undergoing IORT for locally advanced rectal cancer from 2001-2009 were reviewed for cancer recurrence, survival, and procedure-related morbidity. Cumulative event rates were estimated using the method of Kaplan and Meier.
RESULTS: Twenty-nine patients with locally advanced (n = 8) or recurrent (n = 21) rectal cancers were treated with IORT and resection. Surgical interventions included low anterior resection, abdominoperineal resection, pelvic exenteration, and a variety of non-anatomic resections of pelvic recurrences. R(0) resections were achieved in 16 patients, while R(1) resections were achieved in 10, and margins were grossly positive in 3 patients. IORT was delivered to all patients over a median area of 48 (42-72) cm(2) at a median dose of 12 (12-15) Gy. Local and overall recurrence rates were 24 % (locally advanced group) and 45 % (recurrent group). Median disease-free and overall survival were 25 and 40 months respectively at a median follow-up of 26 (18-42) months. The short-term (≤30 days) complication rate was 45 %. Eight patients developed local wound complications, 5 of which required operative intervention. Four patients developed intra-abdominal abscesses requiring drainage. Long-term (>30 days) complications were identified in 11 patients (38 %) and included long-term wound complications (n = 3), ureteral obstruction requiring stenting (n = 1), neurogenic bladder (n = 3), enteric fistulae (n = 2), small bowel obstruction (n = 1), and neuropathic pain (n = 1).
CONCLUSIONS: Intraoperative brachytherapy is a viable IORT option during pelvic surgery for locally advanced or recurrent colorectal cancer but is associated with high postoperative morbidity. Whether intraoperative brachytherapy can improve local recurrence rates for locally advanced or recurrent colorectal cancer will require further prospective investigation.
Authors:
R S Turley; B G Czito; J C Haney; D S Tyler; C R Mantyh; J Migaly
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Publication Detail:
Type:  Journal Article     Date:  2012-09-18
Journal Detail:
Title:  Techniques in coloproctology     Volume:  17     ISSN:  1128-045X     ISO Abbreviation:  Tech Coloproctol     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-15     Completed Date:  2013-09-23     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  9613614     Medline TA:  Tech Coloproctol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  95-100     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Abdominal Abscess / etiology
Aged
Brachytherapy* / adverse effects
Carcinoma / radiotherapy*,  surgery
Colorectal Neoplasms / radiotherapy*,  surgery
Cutaneous Fistula / etiology
Disease-Free Survival
Female
Humans
Intestinal Fistula / etiology
Intestinal Obstruction / etiology
Intraoperative Care
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Recurrence, Local / radiotherapy*,  surgery
Neuralgia / etiology
Radiotherapy Dosage
Retrospective Studies
Surgical Wound Infection / etiology*
Ureteral Obstruction / etiology
Urinary Bladder, Neurogenic / etiology
Vaginal Fistula / etiology
Grant Support
ID/Acronym/Agency:
L32 MD005351/MD/NIMHD NIH HHS
Comments/Corrections

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