Abstract
BACKGROUND: Local recurrence remains one of the most complex problem in the
management of rectal carcinoma. Often, surgery alone is not able to prevent
local recurrence development, particularly in locally advanced cancer. A better
local control is obtained using the association with radiotherapy and
chemotherapy. Intraoperative Radiation Therapy (IORT) represents an innovative
therapeutic modality. PATIENTS AND METHODS: 141 patients, 97 with "high risk"
cancer (T2N1-2 or T3N0-2) and 44 with "locally advanced" tumor (T3N3, T4N0-3 or
local recurrence). 64 patients with extraperitoneal "high risk" rectal cancer
have been treated with preoperative radiotherapy (38 Gy), surgical excision and
IORT (10 Gy). In other 33 "high risk" cases, preoperative radio- (50.4 Gy)
chemotherapy (Tomudex 2-3 mg), surgery and IORT (10 Gy) have been given. Fourty
four patients with "locally advanced" rectal tumor have had external
radiotherapy (48 Gy) + chemotherapy (5FU + Mitomicin C) preoperatively, surgery,
IORT (10-15 Gy) and chemotherapy (5FU + Levamisolo) postoperatively. RESULTS:
Among "high risk" patients, 52-83% of cases have had a sphincter-saving surgical
procedure, 5-year local control is 93%, 5-year overall survival 80%, and 5-year
disease free survival 77%. In 50-60% of "high risk" tumors treated with
preoperative chemo-radiotherapy the pathologic staging have found a T0-1 tumor.
Among "locally advanced" primary tumors, 5-year local control is 90.9%, 5-year
disease free survival 47.1%, 5-year overall survival 60.7%. Among patients
treated for local recurrence, in 60% a complete tumor resection has been
performed; 5-year local control is 79.5%, 5-year disease free survival 19.4%,
5-year overall survival 41.4%. CONCLUSIONS: Integrated treatment with
radiotherapy, chemotherapy, surgery and IORT has allowed a good local control
and seems prolong survival also.
Titolo tradotto del contributo | [Autom. eng. transl.] Intraoperative radiotherapy (IORT) in the treatment of rectal cancer |
---|---|
Lingua originale | Italian |
pagine (da-a) | 567-571 |
Numero di pagine | 5 |
Rivista | Annali Italiani di Chirurgia |
Stato di pubblicazione | Pubblicato - 2001 |
Keywords
- cancro del retto