RECURRENCES OF RECTAL CANCERS - RESULTS OF A MULTIMODAL APPROACH WITHINTRAOPERATIVE RADIATION-THERAPY

Purpose: Prognosis of recurrent rectal cancer remains poor, mainly bec ause of the difficulties of achieving a satisfactory local control, In traoperative radiation therapy (IORT) allows for the delivery of a com plementary single dose to the tumor residues or to the tumor bed and c ould be useful in a multimodal treatment, In an attempt to evaluate th is interest, a retrospective analysis of patients treated with IORT in six French hospitals has been performed. Methods and Materials: Data have been collected in 73 patients (41 men), with a mean age of 62 yea rs, treated with IORT, Initial rectal tumors were large (mean diameter : 45 mm), partially or totally fixed to the contiguous structures in 3 9%, and with nodal involvement in 50% of the cases, Initial surgery ha d been a sphincter-sparing surgery in 67%; external radiation therapy had been delivered in 52%, and a chemotherapy had been given in 10% of the patients, Recurrences were isolated (without metastases) in 86%, and were posterior or posterolateral in 55% of the cases, Surgery allo wed for a complete macroscopical resection in 57%, a partial resection with gross residual disease in 29%, and no resection in 14% of the re currences, Intraoperative radiation therapy was delivered in a dose of 10 to 25 Gy (mean 18.5) through localizators of a mean diameter of 75 mm (60 to 110), External radiation therapy, either preoperative or po stoperatively was given to 30 patients without prior radiation therapy , Ten patients received additional chemotherapy with 5-fluorouracil. R esults: Pour postoperative deaths occurred, Postoperative morbidity oc curred in 16 patients and some complications were probably related to the IORT procedure, Four long-term complications were observed, Overal l actuarial survival occurred in 72.4% of the patients at 1 year, in 4 4.6% at 2 years, and in 30.6% at 3 years, Twenty-one local failures ha ve been observed, Actuarial local control occurred in 71.3% of the pat ients at 1 year, 47.7% at 2 years, and 31.3% at 3 years. Conclusion: I ntraoperative radiation therapy is a complementary treatment for recur rences of rectal cancer, It provides encouraging results, particularly in some selected situations, when patients have not previously been t reated with external radiation therapy, Further studies of multimodal treatments are necessary.