Adjuvant Chemoradiation Plus Intraoperative Radiotherapy Versus Adjuvant Chemoradiation Alone in Patients With Locally Advanced Rectal Cancer. (February 2015)

• Record Type: Journal Article
• Authors: Zhang, Qing; Tey, Jeremy; Yang, Zhe; Li, Ping; Peng, Lihua; Fu, Shen; Huang, Guofeng; Xiong, Fei; Lu, Jiade J.
• Is Part Of: American journal of clinical oncology. Volume 38:Number 1(2015)
• Publication Date: 2015-02
• Subjects: Cancer -- Treatment -- Periodicals; Oncology -- Periodicals; Tumors -- Periodicals; 616.994005
• DOI: 10.1097/COC.0b013e318287bb8d
• Languages: English
• ISSNs: 0277-3732

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objectives:</title> <p>To document the efficacy of intraoperative radiotherapy (IORT) followed by adjuvant chemoradiation in the management of locally advanced rectal cancer.</p> </sec> <sec> <title>Materials and Methods:</title> <p>A total of 148 patients with pT4N0/T1-4N+ rectal adenocarcinoma were enrolled. Seventy-seven patients received total mesorectal excision surgery followed by adjuvant chemoradiation alone, 71 patients received total mesorectal excision surgery followed by IORT (range, 10 to 20 Gy) and adjuvant chemoradiation.</p> </sec> <sec> <title>Results:</title> <p>The 5-year local control (LC) and disease-free survival were 79.2% versus 89.7% (<italic>P</italic>=0.032), 58.5% versus 69.0% (<italic>P</italic>=0.049) for external-beam radiation (EBRT) and IORT+EBRT groups, respectively. Multivariate analysis revealed that adjuvant IORT has a trend toward improvement of LC (<italic>P</italic>=0.079); 5 (3%) patients (EBRT n=2; IORT n=3) experienced incomplete intestinal obstruction and 3 patients had chronic diarrhea. There was no clinically relevant neuropathy or sacral osteoradionecrosis. Hydronephrosis occurred in 13 patients (EBRT n=8; IORT+EBRT n=5), 8 of whom had documented concomitant disease recurrence.</p> </sec> <sec> <title>Conclusions:</title> <p>For patients with locally advanced rectal cancer, higher radiation dose may contribute to the improvement of both LC and disease-free survival, without significantly increasing the incidence of acute and long-term complications compared with adjuvant chemoradiotherapy alone.</p> </sec> </abstract>