Abstract
Introduction: As one of the multimodal treatment options available in locally advanced or recurrent rectal cancer, intraoperative radiotherapy IORT may be a preferred option to achieve local control. In this study, we aim to report on our experience with those recurrent rectal cancer cases which were treated with radical surgery and intraoperative radiotherapy.Methods: Cases treated with radical surgery and IORT for recurrent rectal cancer between November 2012 and December 2016 at Acibadem Mehmet Ali Aydinlar University Medical Faculty Hospital, Maslak, Istanbul, were included in this study.Results: 8 patients 4 male, 4 female with recurrent rectal cancer were included in this study. All the patients had recurrent adenocarcinoma. The median age was 54.5 and median BMI was 34.3 range 19.6-32.5 kg/m2. In all cases, the previous surgery undertaken was sphincter-preserving resection. For recurrent tumors, low anterior resection was performed on 4 patients, abdominoperineal resection was performed on 2 patients and pelvic exenteration was performed on 2 patients. R0 resection was observed in 5, R1 in 2, and R2 in 1 patient. At short-term follow-up, infection had developed at the operative site in 2 patients. The median hospital stay was 8 days. During the median follow-up period of 36 months, 4 patients were observed to be disease-free, 2 patients had pelvic recurrence and 2 patients died.Conclusion: IORT increases the effectiveness of surgery for local control in recurrent rectal cancer and additionally decreases the risk of toxicity, thus enabling the application of high dose radiotherapy
References
- Kapiteijn E, Marijnen CAM, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–46. [CrossRef]
- Bakx R, Visser O, Josso J, Meijer S, Slors JFM, van Lanschot JJB. Management of recurrent rectal cancer: a population based study in greater Amsterdam. World J Gastroenterol 2008;14:6018–23. [CrossRef]
- Wanebo HJ, Koness RJ, Vezeridis MP, Cohen SI, Wrobleski DE. Pelvic resection of recurrent rectal cancer. Ann Surg 1994;220;586–97. [CrossRef]
- Pacelli F, Tortorelli AP, Rosa F, Bossola M, Sanchez AM, Papa V, et al. Locally recurrent rectal cancer: prognostic factors and long-term outcomes of multimodal therapy. Ann Surg Oncol 2010;17:152–62. [CrossRef]
- Harris CA, Solomon MJ, Heriot AG, Sagar PM, Tekkis PP, Dixon L, et al. The Outcomes and Patterns of Treatment Failure After Surgery for Locally Recurrent Rectal Cancer. Ann Surg 2016;264:323–9. [CrossRef]
- Hogan NM, Joyce MR. Surgical management of locally recurrent rectal cancer. Int J Surg Oncol 2012;2012. [CrossRef]
- Gunderson LL, Willet CG, Calvo FA, Harrison LB, edidors. Intraoperative Irradiation: Techniques and Results, 2nd ed. New York: Humana Press; 2011. Erişim: http://radiationondemand.com/ wp-content/uploads/2018/03/2011-Gunderson-Intraoperative- Irradiation.pdf
- Willett CG1, Czito BG, Tyler DS. Intraoperative radiation therapy. J Clin Oncol 2007;25:971–7. [CrossRef]
- Haddock MG. Intraoperative radiation therapy for colon and rectal cancers: a clinical review. Radiat Oncol 2017;12:11. [CrossRef]
- Sagar PM, Pemberton JH. Surgical management of locally recurrent rectal cancer. Br J Surg 1996;83:293–304. [CrossRef]
- Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 2008;26:303–12. [CrossRef]
- Dresen RC, Gosens MJ, Martijn H, Nieuwenhuijzen GA, Creemers GJ, Daniels-Gooszen AW, et al. Radical Resection After IORT-Containing Multimodality Treatment is the Most Important Determinant for Outcome in Patients Treated for Locally Rectal Cancer. Ann Surg Oncol 2008;115:1937–47. [CrossRef]
- Alberda WJ, Verhoef C, Schipper ME, Nuyttens JJ, Rothbarth J, de Wilt JHW, Burger JWA. The Importance of a Minimal Tumor-Free Resection Margin in Locally Recurrent Rectal Cancer. Dis Colon Rectum 2015;58:677–85. [CrossRef]
- Suzuki K, Devine RM, Dozois RR, Gunderson LL, Martenson JA, Weaver AL, et al. Intraoperative Irradiation after Palliative Surgery for Locally Recurrent Rectal Cancer. Cancer 1995;75:939–52. [CrossRef]
- Hahnioser D, Nelson H, Gunderson H, Hassan I, Haddock MG, O’Connell MJ, et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 2003;237:502–8. [CrossRef]
- Lindel K, Willett CG, Shellito PC, Ott MJ, Clark J, Grossbard M, et al. Intraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer. Radiother Oncol 2001;58:83–7. [CrossRef]
- Mannaerts GH, Rutten HJ, Martijn H, Hanssens PEJ, Wiggers T. Comparison of intraoperative radiation therapy-containing multimodality treatment with historical treatment modalities for locally recurrent rectal cancer. Dis Colon Rectum 2001;44:1749–58. [CrossRef]
- Mannaerts GH, Martijn H, Crommelin MA, Stultiëns GNM, Dries W, van Driel OJR, Rutten HJT. Intraoperative electron beam radiation therapy for locally recurrent rectal carcinoma. Int J Radiat Oncol Biol Phys 1999;45:297–308. [CrossRef]
- Allee PE, Tepper JE, Gunderson LL, Munzenrider JE. Postoperative radiation therapy for incompletely resected colorectal carcinoma. Int J Radiat Oncol Biol Phys 1989;17:1171–6. [CrossRef]
- O’Connell MJ, Childs DS, Moertel CG, Holbrook MA, Schutt AJ, Rubin J, Ritts RE. A Prospective Controlled Evaluation of Combined Pelvic Radiotherapy and Methanol Extraction Residue of BCG (MER) For Locally Unresectable or Recurrent Rectal Carcinoma. Int J Radiat Oncol Biol Phys 1982;8:1115–9. [CrossRef]
- Schild SE, Martenson JA, Gunderson LL, Dozois RR. Long-term Survival and Patterns of Failure after Postoperative Radiation Therapy for Subtotally Resected Rectal Adenocarcinoma. Int J Radiat Oncol Biol Phys 1989;16:459–63. [CrossRef]
- Wiig JN, Tveit KM, Poulsen JP, Olsen DR, Giercksky KE. Preoperative irradiation and surgery for recurrent rectal cancer. Will intraoperative radiotherapy (IORT) be of additional benefit? A prospective study. Radiother Oncol 2002;62:207–13. [CrossRef]
- Hyngstrom JR, Tzeng CW, Beddar S, Das P, Krishnan S, Delclos ME, et al. Intraoperative Radiation Therapy for Locally Advanced Primary and Recurrent Colorectal Cancer: Ten-Year Institutional Experience. J Surg Oncol 2014;109:652–8. [CrossRef]
- Bussieres E, Gilly FN, Rouanet P, Mahé MA, Roussel A, Delannes M, et al. Recurrences of rectal cancers: results of a multimodal approach with intraoperative radiation therapy. French Group of IORT. Intraoperative Radiation Therapy. Int J Radiat Oncol Biol Phys 1996;34:49–56. [CrossRef]
- Klaver YL, Lemmens VE, Nienhuijs SW, Nieuwenhuijzen GAP, Rutten HJT, de Hingh IHJT. Intraoperative radiotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Five consecutive case reports of locally advanced rectal cancer with synchronous peritoneal carcinomatosis. Strahlenther Onkol 2013;189:256–60. [CrossRef]
- Mohiuddin M, Marks G, Marks J. Long-Term Results of Reirradiation for Patients with Recurrent Rectal Carcinoma. Cancer 2002;95:1144– 50. [CrossRef]
- Mirnezami R, Chang GJ, Das P, Chandrakumaran K, Tekkis P, Darzi A, Mirnezami AH. Intraoperative radiotherapy in colorectal cancer: systematic review and meta-analysis of techniques, long-term outcomes, and complications. Surg Oncol 2013;22:22–35. [CrossRef]
- Klink CD, Binnebösel M, Holy R, Neumann UP, Junge K. Influence of Intraoperative Radiotherapy (IORT) on Perioperative Outcome after Surgical Resection of Rectal Cancer. World J Surg 2014;38:992–6. [CrossRef]
Abstract
Giriş: Lokal ileri ve nüks rektum kanserinde multimodal tedavi seçeneklerden biri olan intraoperatif radyoterapi İORT , lokal kontrolü sağlamak için tercih edilebilir. Bu çalışmada nüks rektum kanseri nedeniyle radikal cerrahi ve intraoperatif radyoterapi uyguladığımız hastalar üzerindeki deneyimimizi sunmayı amaçladık.Metod: Acıbadem Mehmet Ali Aydınlar Üniversitesi Tıp Fakültesi, Maslak Hastanesi’nde Kasım 2012 ve Aralık 2016 tarihleri arasında nüks rektum kanseri nedeniyle radikal cerrahi ve İORT uygulanan hastaların klinik özellikleri ve ameliyat sonrası takipleri değerlendirildi.Bulgular: Çalışmamıza nüks rektum kanseri olan 8 hasta 4 kadın dahil edildi. Tüm hastalarda nüks adenokarsinom mevcuttu. Hastaların ortanca yaş değeri 54.5 ve vücut kitle indeksi 24.3 19.6-32.5 kg/m2 idi. Rektum kanseri için yapılan ilk ameliyatların tümü sfinkter koruyucu rezeksiyondu. Nüks tümör nedeniyle 4 hastaya aşağı anterior rezeksiyon, 2 hastaya abdominoperineal rezeksiyon, 2 hastaya da pelvisten kitle çıkarılması işlemi uygulandı. 5 hastaya R0, 2 hastaya R1 ve 1 hastaya R2 rezeksiyon yapıldı. Ameliyat sonrası erken dönem takiplerinde 2 hastada cerrahi yara enfeksiyonu gelişti. Ortanca hastanede kalış süresi 8 gündü. Ortanca 35.5 aylık takip süresince 4 hasta hastalıksız takip edilmektedir. İki hastada pelvik nüks gelişti. İki hasta eksitus oldu.Sonuç: Nüks rektum kanserinde intraoperatif radyoterapi, toksisite riskini azaltarak yüksek doz radyoterapi uygulayabilmemize olanak sağlayan ve bu yolla cerrahinin lokal kontrol üzerindeki etkinliğini artıran bir yöntemdir
References
- Kapiteijn E, Marijnen CAM, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–46. [CrossRef]
- Bakx R, Visser O, Josso J, Meijer S, Slors JFM, van Lanschot JJB. Management of recurrent rectal cancer: a population based study in greater Amsterdam. World J Gastroenterol 2008;14:6018–23. [CrossRef]
- Wanebo HJ, Koness RJ, Vezeridis MP, Cohen SI, Wrobleski DE. Pelvic resection of recurrent rectal cancer. Ann Surg 1994;220;586–97. [CrossRef]
- Pacelli F, Tortorelli AP, Rosa F, Bossola M, Sanchez AM, Papa V, et al. Locally recurrent rectal cancer: prognostic factors and long-term outcomes of multimodal therapy. Ann Surg Oncol 2010;17:152–62. [CrossRef]
- Harris CA, Solomon MJ, Heriot AG, Sagar PM, Tekkis PP, Dixon L, et al. The Outcomes and Patterns of Treatment Failure After Surgery for Locally Recurrent Rectal Cancer. Ann Surg 2016;264:323–9. [CrossRef]
- Hogan NM, Joyce MR. Surgical management of locally recurrent rectal cancer. Int J Surg Oncol 2012;2012. [CrossRef]
- Gunderson LL, Willet CG, Calvo FA, Harrison LB, edidors. Intraoperative Irradiation: Techniques and Results, 2nd ed. New York: Humana Press; 2011. Erişim: http://radiationondemand.com/ wp-content/uploads/2018/03/2011-Gunderson-Intraoperative- Irradiation.pdf
- Willett CG1, Czito BG, Tyler DS. Intraoperative radiation therapy. J Clin Oncol 2007;25:971–7. [CrossRef]
- Haddock MG. Intraoperative radiation therapy for colon and rectal cancers: a clinical review. Radiat Oncol 2017;12:11. [CrossRef]
- Sagar PM, Pemberton JH. Surgical management of locally recurrent rectal cancer. Br J Surg 1996;83:293–304. [CrossRef]
- Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 2008;26:303–12. [CrossRef]
- Dresen RC, Gosens MJ, Martijn H, Nieuwenhuijzen GA, Creemers GJ, Daniels-Gooszen AW, et al. Radical Resection After IORT-Containing Multimodality Treatment is the Most Important Determinant for Outcome in Patients Treated for Locally Rectal Cancer. Ann Surg Oncol 2008;115:1937–47. [CrossRef]
- Alberda WJ, Verhoef C, Schipper ME, Nuyttens JJ, Rothbarth J, de Wilt JHW, Burger JWA. The Importance of a Minimal Tumor-Free Resection Margin in Locally Recurrent Rectal Cancer. Dis Colon Rectum 2015;58:677–85. [CrossRef]
- Suzuki K, Devine RM, Dozois RR, Gunderson LL, Martenson JA, Weaver AL, et al. Intraoperative Irradiation after Palliative Surgery for Locally Recurrent Rectal Cancer. Cancer 1995;75:939–52. [CrossRef]
- Hahnioser D, Nelson H, Gunderson H, Hassan I, Haddock MG, O’Connell MJ, et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 2003;237:502–8. [CrossRef]
- Lindel K, Willett CG, Shellito PC, Ott MJ, Clark J, Grossbard M, et al. Intraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer. Radiother Oncol 2001;58:83–7. [CrossRef]
- Mannaerts GH, Rutten HJ, Martijn H, Hanssens PEJ, Wiggers T. Comparison of intraoperative radiation therapy-containing multimodality treatment with historical treatment modalities for locally recurrent rectal cancer. Dis Colon Rectum 2001;44:1749–58. [CrossRef]
- Mannaerts GH, Martijn H, Crommelin MA, Stultiëns GNM, Dries W, van Driel OJR, Rutten HJT. Intraoperative electron beam radiation therapy for locally recurrent rectal carcinoma. Int J Radiat Oncol Biol Phys 1999;45:297–308. [CrossRef]
- Allee PE, Tepper JE, Gunderson LL, Munzenrider JE. Postoperative radiation therapy for incompletely resected colorectal carcinoma. Int J Radiat Oncol Biol Phys 1989;17:1171–6. [CrossRef]
- O’Connell MJ, Childs DS, Moertel CG, Holbrook MA, Schutt AJ, Rubin J, Ritts RE. A Prospective Controlled Evaluation of Combined Pelvic Radiotherapy and Methanol Extraction Residue of BCG (MER) For Locally Unresectable or Recurrent Rectal Carcinoma. Int J Radiat Oncol Biol Phys 1982;8:1115–9. [CrossRef]
- Schild SE, Martenson JA, Gunderson LL, Dozois RR. Long-term Survival and Patterns of Failure after Postoperative Radiation Therapy for Subtotally Resected Rectal Adenocarcinoma. Int J Radiat Oncol Biol Phys 1989;16:459–63. [CrossRef]
- Wiig JN, Tveit KM, Poulsen JP, Olsen DR, Giercksky KE. Preoperative irradiation and surgery for recurrent rectal cancer. Will intraoperative radiotherapy (IORT) be of additional benefit? A prospective study. Radiother Oncol 2002;62:207–13. [CrossRef]
- Hyngstrom JR, Tzeng CW, Beddar S, Das P, Krishnan S, Delclos ME, et al. Intraoperative Radiation Therapy for Locally Advanced Primary and Recurrent Colorectal Cancer: Ten-Year Institutional Experience. J Surg Oncol 2014;109:652–8. [CrossRef]
- Bussieres E, Gilly FN, Rouanet P, Mahé MA, Roussel A, Delannes M, et al. Recurrences of rectal cancers: results of a multimodal approach with intraoperative radiation therapy. French Group of IORT. Intraoperative Radiation Therapy. Int J Radiat Oncol Biol Phys 1996;34:49–56. [CrossRef]
- Klaver YL, Lemmens VE, Nienhuijs SW, Nieuwenhuijzen GAP, Rutten HJT, de Hingh IHJT. Intraoperative radiotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Five consecutive case reports of locally advanced rectal cancer with synchronous peritoneal carcinomatosis. Strahlenther Onkol 2013;189:256–60. [CrossRef]
- Mohiuddin M, Marks G, Marks J. Long-Term Results of Reirradiation for Patients with Recurrent Rectal Carcinoma. Cancer 2002;95:1144– 50. [CrossRef]
- Mirnezami R, Chang GJ, Das P, Chandrakumaran K, Tekkis P, Darzi A, Mirnezami AH. Intraoperative radiotherapy in colorectal cancer: systematic review and meta-analysis of techniques, long-term outcomes, and complications. Surg Oncol 2013;22:22–35. [CrossRef]
- Klink CD, Binnebösel M, Holy R, Neumann UP, Junge K. Influence of Intraoperative Radiotherapy (IORT) on Perioperative Outcome after Surgical Resection of Rectal Cancer. World J Surg 2014;38:992–6. [CrossRef]
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | September 1, 2019 |
| Published in Issue | Year 2019Issue: 3 |