Intensification of Local Therapy With High Dose Rate, Intraoperative Radiation Therapy (HDR-IORT) and Extended Resection for Locally Advanced and Recurrent Colorectal Cancer,Clinical Colorectal Cancer

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Intensification of Local Therapy With High Dose Rate, Intraoperative Radiation Therapy (HDR-IORT) and Extended Resection for Locally Advanced and Recurrent Colorectal Cancer
Clinical Colorectal Cancer ( IF 3.4 ) Pub Date : 2023-03-26 , DOI: 10.1016/j.clcc.2023.03.002
Ryan Anthony F Agas ₁ , Jennifer Tan ₁ , Jing Xie ₂ , Sylvia Van Dyk ₁ , Joseph C H Kong ₃ , Alexander Heriot ₄ , Samuel Y Ngan ₅

Affiliation

Background

We report our long-term experience with high dose rate intraoperative radiotherapy (HDR-IORT) in a single, quaternary institution.

Patients/Methods

From 2004 to 2020, 60 HDR-IORT procedures for locally advanced colorectal cancer (LACC) and 81 for locally recurrent colorectal cancer (LRCC) were done in our institution. Preoperative radiotherapy was done prior to majority of the resections (89%, 125/141). Sixty-nine percent (58/84) of the resections involving pelvic exenterations had >3 en bloc organs resected. HDR-IORT was delivered using a Freiburg applicator. A single 10 Gy fraction was delivered. Margin status was R0 and R1 in 54% (76/141) and 46% (65/141) of the resections, respectively.

Results

With a median follow-up time of 4 years, 3-, 5-, and 7- year, overall survival (OS) rates were 84%, 58%, and 58% for LACC and 68%, 41%, and 37% for LRCC, respectively. Local progression-free survival (LPFS) rates were 97%, 93%, and 93% for LACC and 80%, 80%, 80% for LRCC, respectively. For the LRCC group, an R1 resection was associated with worse OS, LPFS, and progression-free survival (PFS), preoperative EBRT was associated with improved LPFS and PFS, and ≥2 years disease-free interval was associated with improved PFS. The most common severe adverse events were postoperative abscess (n = 25) and bowel obstruction (n = 11). There were 68 grade 3 to 4 and no grade 5 adverse events.

Conclusions

Favorable OS and LPFS can be achieved for LACC and LRCC with intensive local therapy. In patients with risk factors for poorer outcomes, optimization of EBRT and IORT, surgical resection, and systemic therapy are required.

中文翻译：

局部晚期和复发性结直肠癌强化高剂量率局部治疗、术中放射治疗 (HDR-IORT) 和扩大切除

背景

我们报告了我们在单一四级机构进行高剂量率术中放疗 (HDR-IORT) 的长期经验。

患者/方法

2004年至2020年，我们机构完成了60例局部晚期结直肠癌（LACC）的HDR-IORT手术和81例局部复发性结直肠癌（LRCC）手术。大多数切除术之前均进行了术前放疗（89%，125/141）。69% (58/84) 涉及盆腔廓清术的切除术中，有 >3 个整块器官被切除。HDR-IORT 使用 Freiburg 敷贴器进行。交付了单个 10 Gy 部分。54% (76/141) 和 46% (65/141) 的切除手术边缘状态分别为 R0 和 R1。

结果

中位随访时间为 4 年、3 年、5 年和 7 年，LACC 的总生存率 (OS) 分别为 84%、58% 和 58%，而 LACC 的总生存率分别为 68%、41% 和 37%分别为LRCC。LACC 的局部无进展生存率 (LPFS) 分别为 97%、93% 和 93%，LRCC 的局部无进展生存率 (LPFS) 分别为 80%、80% 和 80%。对于 LRCC 组，R1 切除与较差的 OS、LPFS 和无进展生存期 (PFS) 相关，术前 EBRT与改善的 LPFS 和 PFS 相关，≥2 年的无病间隔与改善的 PFS 相关。最常见的严重不良事件是术后脓肿（n = 25）和肠梗阻（n = 11）。共有 68 例 3 至 4 级不良事件，无 5 级不良事件。