PREOPERATIVE INFUSIONAL CHEMORADIATION, SELECTIVE INTRAOPERATIVE RADIATION, AND RESECTION FOR LOCALLY ADVANCED PELVIC RECURRENCE OF COLORECTAL ADENOCARCINOMA

Objective The results of preoperative infusional chemoradiation, resec tion, and selective intraoperative radiation (IORT) boost in 43 previo usly nonirradiated patients with locally advanced pelvic recurrence of colorectal adenocarcinoma are described. Summary Background Data Afte r surgery alone, 10% to 30% of patients with carcinoma of the distal c olon and rectum will develop isolated pelvic recurrence. In most cases , the disease is locally advanced and not amenable to curative resecti on. Preoperative infusional chemoradiation has been shown to increase resectability and decrease local recurrence in primary locally advance d colorectal cancer. Based on this experience, we initiated a multimod ality treatment protocol to treat patients with pelvic recurrence of c olorectal adenocarcinoma. Methods Forty-three consecutive patients wit h histologically proven pelvic recurrence of colorectal adenocarcinoma were enrolled on a multimodality treatment protocol. The treatment pl an consisted of 5 weeks of concurrent pelvic external beam radiotherap y (45 Gy) with continuous intravenous infusion of 5-fluorouracil and/o r cisplatin. This was followed by surgery that included IORT boost (10 -20 Gy) for 21 patients and brachytherapy for 4 patients. Results Fort y patients (93%) underwent operation and 33 (77%) underwent resection with curative intent. There were 29 (88%) margin-negative resections. Fifteen patients (48%) underwent sphincter-preserving operations. Ther e were no treatment-related deaths. Twenty-two patients experienced pe rioperative complications. Median follow-up for the 43 patients was 26 months. The local recurrence rate was 36%. Median survival for the pa tients who underwent resection was 34 months, and actuarial 5-year dis ease-free and overall survival were 37% and 58%, respectively. Conclus ions Tumor cytoreduction by preoperative chemoradiation can increase r esectability and enable sphincter preserving surgery in patients with locally advanced pelvic recurrence of colorectal cancer.