INTRAOPERATIVE RADIOTHERAPY IN LOCALLY ADVANCED RECURRENT COLORECTAL-CANCER

Purpose: In an effort to promote local control and improve quality of life in patients with recurrent colorectal cancer, a multimodality app roach has been used. Methods and Materials: Twenty-seven patients were treated with moderate doses of pre/postoperative radiotherapy with/wi thout simultaneous systemic chemotherapy, surgical re-resection and IO RT electron boost over areas at high risk for local recurrence. Result s: The 2-year actuarial disease-free and local relapse-free survival f or the entire group were 14% and 26%, respectively. The most important factor predicting a favorable outcome was the radicality of surgical procedure. The determinate local control rate and the actuarial 2-year local relapse-free, and disease-free survival for patients undergoing complete resections were 50%, 56%, and 34%, respectively, whereas for patients undergoing partial resections these figures were 16%, 13%, a nd 6%. The radicality of surgical procedure was influenced by both tum oral size and previous treatment with irradiation. Complete resection rate was higher in patients with tumors less than 5 cm vs. more than 5 cm (40% vs. 22%), and in patients without previous radiotherapy versu s those with previous radiotherapy (40% vs. 28%). Distant metastasis r ate was high (41%). The most significant toxicities attributable to th e whole treatment protocol were enteritis (37%), hydronephrosis (30%), and pelvic neuropathy (52%). Conclusion: Currently, our policy is to recommend IORT in patients with ''favorable factors'' such as: absence of previous pelvic radiotherapy, single previous surgical procedure, and complete resections.