Colorectales Carcinom – Behandlungsalternative durch intraoperative Radiotherapie mittels Afterloading-flab-Technik?

Abstract

Intraoperative radiotherapy (IORT) is a new concept in the treatment of recurrent and primary advanced colorectal tumors. Between October 1994 and December 1997 27 patients (primary tumor: 8, first recurrent tumor: 12, second recurrent tumor: 7) received IORT (32 applications). Chemotherapy and percutaneous radiotherapy had already been given to all patients with advanced and recurrent colorectal tumors. The intraoperative irradiation was performed through HDR iridium afterloading. A flexible flab--individually adapted to the "tumor bed"--was used as applicator. The contact dose ranged from 10 to 15 Gy. The mean operation time (rectum resection: 5, rectum amputation: 14, debulking: 8) increased by 30 min on average. Eight patients had postoperative complications: perianal wound infections (3), sacrovesical fistulas (3), leakage of anastomosis (1) and neural ureter dysfunction (1). To date--on average 17.1 months (range: 3-33) after operation--13 patients are free of tumor recurrence or show stable disease. Ten patients--all of them had macroscopic residual tumor--have local tumor progression combined with good quality of life. Only 4 patients died (acute kidney failure, stroke, marasmus, systemic progression). The afterloading flab technique represents a technically simple, minimally harmful procedure in the therapy of colorectal tumor. Even when IORT with electrons is not feasible or the patients have already been irradiated, a higher radiation dose is possible. Given the demonstrated rate of local tumor recurrence, the afterloading flab technique seems to be a valuable treatment alternative to extended, high-risk resections. Long-term follow-ups will be necessary.

Die intraoperative Radiotherapie als Bestandteil multimodaler Therapiekonzepte bei epithelialen Tumoren des Gastrointestinaltrakts

“…Die perioperative Letalität und Komplikationsrate durch zusätzliche IORT ist bei Applikation von 10±15 Gy nach Literaturangaben gegenüber alleiniger Resektion nicht wesentlich erhöht [12±14, 30,57,61]. Am häufigsten sind perineale Wundheilungsstörungen und perineale Abscesse, eine Anastomoseninsuffizienz tritt nach kontinenzerhaltender Resektion in ca.…”

CT-Based Navigation Systems for Intraoperative Radiotherapy Using the Afterloading-Flab Technique

“…According to a technique published elsewhere [5], a silicon flab is used for radiotherapy. The flexible applicator, consisting of a mat of spherules with centrally placed parallel hollow catheters (fig.…”

“…Intraoperative radiotherapy (IORT) using the afterloading-flab technique is a possibility for treatment of these patients. It enables better control of local tumor growth and possibly improves patient survival [5]. …”