Moderate dose intraoperative and external beam radiotherapy for locally recurrent rectal carcinoma

Background and purpose: Late adverse effects (i.e. neuropathy, chronic bowe l obstruction) limit the effective dose given in intraoperative radiotherap y (IORT) and external beam radiotherapy (EBRT). Initial results of a multi- modality treatment approach using moderate dose IORT and moderate dose EBRT are presented. Patients ann methods: Thirty-one consecutive patients with recurrent rectal carcinomas had IORT and EBRT after complete (R0, n = 14) or incomplete res ection (R1, n = 9; R2, II = 8). The mean IORT dose was 13.7 Gy (range 12-20 Gy) supplemented with an EBRT dose of 41.4 Gy. Twenty-two patients had pre operative EBRT and 22 patients had concomitant chemotherapy (5-FU, Leucovor ine). Results: After a median follow-up of 28 months, 16 patients had re-recurren t disease and 11 patients had died. Nine patients failed locally (four in-f ield, four marginal and one anastomotic re-recurrence), three combined with distant metastasis, resulting in overall and IORT infield local control ra tes of 71% and 87%, respectively. Distant metastases alone were found in se ven patients. The 4-year overall and relapse-free survival rates were 58% a nd 48%, respectively. After incomplete resection the local failure rate inc reased (RO 21%, R1/2 35%) and the 4-year relapse-free survival rate decreas ed significantly (29% versus 71%) due to a markedly increased distant metas tasis rate (53% versus 7%). Acute and late toxicities were not increased. Conclusion: The combination of moderate dose IORT and EBRT is a safe and ef ficacious component in a multi-modality treatment approach. (C) 1998 Elsevi er Science Ireland Ltd. All rights reserved.