Intraoperative radiotherapy as an immediate adjuvant treatment of rectal cancer due to limited access to external-beam radiotherapy.
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ABSTRACT: BACKGROUND:Neoadjuvant external-beam radiotherapy (EBRT) with concomitant chemotherapy is the current standard-of-care for locally-advanced rectal cancer. Intraoperative radiotherapy (IORT) is to date only recommended for pelvic recurrences or incompletely resectable tumors. We here report on patients with stage II/III rectal cancer that were treated with IORT in a regional Russian university center due to limited access to EBRT. METHODS:We retrospectively analyzed data from patients that were diagnosed with locally-advanced rectal cancer and underwent surgery from December 2012 to October 2016 at a regional oncological center in Russia (Krasnodar). During this period, access to EBRT was limited due to a temporary lack of a sufficient number of EBRT facilities. Patients unable to travel to a distant radiotherapy site received IORT alone, those that could travel received neoadjuvant external beam (chemo-) radiotherapy. Factors of interest were tumor stage, tumor differentiation, resection status, surgery type and neoadjuvant or adjuvant chemotherapy. We assessed local progression-free survival (L-PFS), PFS and overall survival (OS). RESULTS:A total of 172 patients were included in this analysis. Of those, 92 (53.5%) were treated with IORT alone (median dose: 15?Gy [8.4-17?Gy]) and 80 (46.5%) received both neoadjuvant EBRT (median dose: 50.4?Gy [40-50.4?Gy]) and IORT (median dose: 15?Gy [15-17?Gy]). The median age was 65?years [33-82]. The median follow-up was 23?months [0-63?months]. The incidence of toxicity was low in both groups with an overall complication rate of 5.4%. Local PFS at 4?years was comparable with 59.4% in the IORT group and 65.4% in the IORT/EBRT group (p?=?0.70). Similarly, there was no difference in OS or PFS (p?=?0.66, p?=?0.51, respectively). CONCLUSIONS:IORT is a valuable option for patients with locally-advanced rectal cancer in the absence of access to EBRT.
SUBMITTER: Potemin S
PROVIDER: S-EPMC6954580 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
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