Chemoradiation with or without intraoperative radiation therapy in patients with locally recurrent rectal carcinoma: Prognostic factors and long term outcome

Vincenzo Valentini, Alessio Giuseppe Morganti, Antonio De Franco, Claudio Coco, Carlo Ratto, Gian Battista Doglietto, Lucio Trodella, Luigi Ziccarelli, Aurelio Picciocchi, Numa Cellini

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

BACKGROUND. Rectal carcinoma patients with local recurrence are reported to have a dismal prognosis. The purpose of this study was to evaluate the effect of combined modality therapy on clinical outcome and to determine the prognostic impact of a 'presurgical' staging system. METHODS. Between September 1989 and June 1997, 47 patients (with a median follow-up of 80 months) with locally recurrent, nonmetastatic rectal carcinoma were classified according to the extent of pelvic sidewall involvement as determined by pretreatment computed tomography (CT) scan. They received preoperative external beam radiation (45-47 grays [Gy] in 34 patients; 23.4 Gy in 13 preirradiated patients) plus concomitant 5-fluorouracil (1000 mg/m2/day as a 96-hour continuous infusion on Days 1-4 + 29-32) and mitomycin C (10 mg/m2 as a bolus intravenously on Day 1 + 29). After 4-6 weeks, the patients were evaluated for surgical resection and intraoperative radiation therapy (IORT) procedure (10-15 Gy) or, in unresectable patients, a boost dose was planned by chemoradiation (23.4 Gy) or brachytherapy. Thereafter, adjuvant chemotherapy (5-fluorouracil and leucovorin for a total of six to nine courses) was prescribed. RESULTS. During chemoradiation, 2 patients (4.3%) developed Radiation Therapy Oncology Group Grade 3-4 acute toxicity. Twenty-five patients (53.2%) had an objective response after chemoradiation. Twenty-one patients (45%) underwent radical surgical resection. The overall 5-year survival and local control rates were 22% and 32%, respectively. The classification system significantly predicted survival (P = 0.008). Radically resected patients had better local control and survival (P < 0.0001); in patients treated with IORT, the 5-year local control and survival rates were 79% and 41%, respectively. CONCLUSIONS. The data from the current study suggest that combined modality therapy was well tolerated and improved resectability, local control, and survival. The classification system appears to be a reliable tool with which to predict clinical outcome in patients with locally recurrent rectal carcinoma.
Lingua originaleEnglish
pagine (da-a)2612-2624
Numero di pagine13
RivistaCancer
Volume86
DOI
Stato di pubblicazionePubblicato - 1999

Keywords

  • 5-fluorouracil
  • Combined modality therapy
  • Continuous infusion
  • External radiation therapy
  • Staging
  • Local recurrence
  • Mitomycin C
  • Prognostic factors
  • Rectal neoplasms
  • Intraoperative radiation therapy

Fingerprint

Entra nei temi di ricerca di 'Chemoradiation with or without intraoperative radiation therapy in patients with locally recurrent rectal carcinoma: Prognostic factors and long term outcome'. Insieme formano una fingerprint unica.

Cita questo