Intraoperative electron beam radiation therapy for locally recurrent rectal carcinoma

Purpose: Treatment results for locally recurrent rectal cancers are poor. T his is a result of the fact that surgery is hampered due to the severance o f the anatomical planes during the primary procedure and that radiotherapy is limited by normal tissue tolerance, especially after previous irradiatio n. This paper describes the results of a combined treatment modality in thi s patient group. Methods and Materials: From 1994 to 1998, 37 patients with locally recurren t rectal cancer, but without distant metastatic disease, received a combine d treatment consisting of 50.4 Gy preoperative irradiation or, in case of p revious radiotherapy, 30 Gy reirradiation or no irradiation, followed by ra dical surgery and intraoperative electron beam radiotherapy boost. Results: Fifteen patients received a radical resection (RO), eight a micros copic irradical resection (R1), and 14 a macroscopic irradical resection (R 2). The overall 3-year local control (LC), disease-free survival (DFS), and overall survival rates were 60%, 32%, and 58% respectively. Radicality of resection (R0/R1 vs. R2) turned out to be the significant factor for improv ed survival (p < 0.05), DFS (p = 0.0008), and LC (p = 0.01). Preoperative ( re-)irradiation is the other significant factor in survival (p = 0.005) and DFS (p = 0.001) and was almost significant for LC (p = 0.08). After extern al beam radiation therapy (EBRT) a significantly higher resection rate was obtained (R0/R1 vs. R2 p = 0.001). Symptomatic peripheral local recurrences have a significantly worse prognosis and higher rate of R2-resection (p = 0.0005). Conclusion: Centralization of locally recurrent rectal cancer patients enab led the development of an aggressive multimodality treatment, which in turn led to promising results, Distant failure is still a drawback. (C) 1999 El sevier Science Inc.