Intraoperative Radiation Therapy Reduces Local Recurrence Rates in Patients With Microscopically Involved Circumferential Resection Margins After Resection of聽Locally Advanced Rectal Cancer

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• 作者：Wijnand J. Alberda ; MD^&lowast ; ; Cornelis Verhoef ; MD ; PhD^&lowast ; ; Joost J. Nuyttens ; MD PhD^&dagger ; ; Esther van Meerten ; MD ; PhD^&Dagger ; ; Joost Rothbarth ; MD ; PhD^&lowast ; ; Johannes H.W. de Wilt ; MD ; PhD^§ ; ; Jacobus W.A. Burger ; MD ; PhD^&lowast ; ; ^{j.burger@erasmusmc.nl" class="auth_mail}
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：1 April, 2014
• 年：2014
• 卷：88
• 期：5
• 页码：1032-1040
• 全文大小：325 K

文摘

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Purpose

Intraoperative radiation therapy (IORT) is advocated by some for patients聽with locally advanced rectal cancer (LARC) who have involved or narrow circumferential resection margins (CRM) after rectal surgery. This study evaluates the potentially beneficial effect of IORT on local control.

Methods and Materials

All surgically treated patients with LARC treated in a tertiary聽referral center between 1996 and 2012 were analyzed retrospectively. The聽outcome in patients treated with IORT with a clear but narrow CRM (鈮?聽mm) or a microscopically involved CRM was compared with the outcome in patients who were not treated with IORT.

Results

A total of 409 patients underwent resection of LARC, and 95 patients (23%) had a CRM聽鈮ぢ?聽mm. Four patients were excluded from further analysis because of a macroscopically involved resection margin. In 43 patients with clear but narrow CRMs, there was no difference in the cumulative 5-year local recurrence-free survival of patients treated with (n=21) or without (n=22) IORT (70% vs 79%, P=.63). In 48 patients with a microscopically involved CRM, there was a significant difference in the cumulative 5-year local recurrence-free survival in favor of the patients treated with IORT (n=31) compared with patients treated without IORT (n=17) (84 vs 41%, P=.01). Multivariable analysis confirmed that IORT was independently associated with a decreased local recurrence rate (hazard ratio 0.24, 95% confidence interval 0.07-0.86). There was no significant difference in complication rate of patients treated with or without IORT (65% vs 52%, P=.18)

Conclusion

The current study suggests that IORT reduces local recurrence rates in patients with LARC with a microscopically involved CRM.