Combined modality therapy including intraoperative electron irradiation for locally recurrent colorectal cancer

Michael Haddock, Robert C. Miller, Heidi Nelson, John H. Pemberton, Eric Dozois, Steven Robert Alberts, Leonard L. Gunderson

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate survival, relapse patterns, and prognostic factors in patients with colorectal cancer relapse treated with curative-intent therapy, including intraoperative electron radiation therapy (IOERT). Methods and Materials: From April 1981 through January 2008, 607 patients with recurrent colorectal cancer received IOERT as a component of treatment. IOERT was preceded or followed by external radiation (median dose, 45.5 Gy) in 583 patients (96%). Resection was classified as R0 in 227 (37%), R1 in 224 (37%), and R2 in 156 (26%). The median IOERT dose was 15 Gy (range, 7.5-30 Gy). Results: Median overall survival was 36 months. Five- and 10-year survival rates were 30% and 16%, respectively. Survival estimates at 5 years were 46%, 27%, and 16% for R0, R1, and R2 resection, respectively. Multivariate analysis revealed that R0 resection, no prior chemotherapy, and more recent treatment (in the second half of the series) were associated with improved survival. The 3-year cumulative incidence of central, local, and distant relapse was 12%, 23%, and 49%, respectively. Central and local relapse were more common in previously irradiated patients and in those with subtotal resection. Toxicity Grade 3 or higher partially attributable to IOERT was observed in 66 patients (11%). Neuropathy was observed in 94 patients (15%) and was more common with IOERT doses exceeding 12.5 Gy. Conclusions: Long-term survival and disease control was achievable in patients with locally recurrent colorectal cancer. Continued evaluation of curative-intent, combined-modality therapy that includes IOERT is warranted in this high-risk population.

Original languageEnglish (US)
Pages (from-to)143-150
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume79
Issue number1
DOIs
StatePublished - Jan 1 2011

Fingerprint

electron radiation
Combined Modality Therapy
electron irradiation
Colorectal Neoplasms
radiation therapy
therapy
Radiotherapy
cancer
Electrons
Survival
Recurrence
dosage
chemotherapy
toxicity
grade
Therapeutics
Multivariate Analysis
Survival Rate
incidence
Radiation

Keywords

  • Colorectal cancer
  • Intraoperative radiation therapy
  • Local disease relapse
  • Radiation tolerance

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Combined modality therapy including intraoperative electron irradiation for locally recurrent colorectal cancer. / Haddock, Michael; Miller, Robert C.; Nelson, Heidi; Pemberton, John H.; Dozois, Eric; Alberts, Steven Robert; Gunderson, Leonard L.

In: International Journal of Radiation Oncology Biology Physics, Vol. 79, No. 1, 01.01.2011, p. 143-150.

Research output: Contribution to journalArticle

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abstract = "Purpose: To evaluate survival, relapse patterns, and prognostic factors in patients with colorectal cancer relapse treated with curative-intent therapy, including intraoperative electron radiation therapy (IOERT). Methods and Materials: From April 1981 through January 2008, 607 patients with recurrent colorectal cancer received IOERT as a component of treatment. IOERT was preceded or followed by external radiation (median dose, 45.5 Gy) in 583 patients (96{\%}). Resection was classified as R0 in 227 (37{\%}), R1 in 224 (37{\%}), and R2 in 156 (26{\%}). The median IOERT dose was 15 Gy (range, 7.5-30 Gy). Results: Median overall survival was 36 months. Five- and 10-year survival rates were 30{\%} and 16{\%}, respectively. Survival estimates at 5 years were 46{\%}, 27{\%}, and 16{\%} for R0, R1, and R2 resection, respectively. Multivariate analysis revealed that R0 resection, no prior chemotherapy, and more recent treatment (in the second half of the series) were associated with improved survival. The 3-year cumulative incidence of central, local, and distant relapse was 12{\%}, 23{\%}, and 49{\%}, respectively. Central and local relapse were more common in previously irradiated patients and in those with subtotal resection. Toxicity Grade 3 or higher partially attributable to IOERT was observed in 66 patients (11{\%}). Neuropathy was observed in 94 patients (15{\%}) and was more common with IOERT doses exceeding 12.5 Gy. Conclusions: Long-term survival and disease control was achievable in patients with locally recurrent colorectal cancer. Continued evaluation of curative-intent, combined-modality therapy that includes IOERT is warranted in this high-risk population.",
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