Intraoperative radiotherapy in colorectal cancer: Systematic review and meta-analysis of techniques, long-term outcomes, and complications

Abstract

Background The precise contribution of IORT to the management of locally advanced and recurrent colorectal cancer (CRC) remains uncertain. We performed a systematic review and meta-analysis to assess the value of IORT in this setting. Methods Studies published between 1965 and 2011 that reported outcomes after IORT for advanced or recurrent CRC were identified by an electronic literature search. Studies were assessed for methodological quality and design, and evaluated for technique of IORT delivery, oncological outcomes, and complications following IORT. Outcomes were analysed with fixed-effect and random-effect model meta-analyses and heterogeneity and publication bias examined. Results 29 studies comprising 14 prospective and 15 retrospective studies met the inclusion criteria and were assessed, yielding a total of 3003 patients. The indication for IORT was locally advanced disease in 1792 patients and locally recurrent disease in 1211 patients. Despite heterogeneity in methodology and reporting practice, IORT is principally applied for the treatment of close or positive margins. When comparative studies were evaluated, a significant effect favouring improved local control (OR 0.22; 95% CI=0.05-0.86; p=0.03), disease free survival (HR 0.51; 95% CI=0.31-0.85; p=0.009), and overall survival (HR 0.33; 95% CI=0.2-0.54; p=0.001) was noted with no increase in total (OR 1.13; 95% CI=0.77-1.65; p=0.57), urologic (OR 1.35; 95% CI=0.84-2.82; p=0.47), or anastomotic complications (OR 0.94; 95% CI=0.42-2.1; p=0.98). Increased wound complications were noted after IORT (OR 1.86; 95% CI=1.03-3.38; p=0.049). Conclusions Despite methodological weaknesses in the studies evaluated, our results suggest that IORT may improve oncological outcomes in advanced and recurrent CRC.

240. Intraoperative radiotherapy with low energy photons in recurrent colorectal cancer: A single centre retrospective study

“…Postoperative mortality associated with the use of IORT ranges from 0 to 3.6%, irrespective of the IORT used [10,23,32]. In the literature, 3-month postoperative mortality rates range from 0% to 8% [4,26,28,29,37,39]. In the present study, two postoperative deaths were reported (2.5%); however, none of them was attributed to the use of IORT.…”

“…Although the use of IORT as a component of combined multimodal therapy may increase the survival by improving the local control, there are no randomized trials on IORT in CRC [9,25]. Meta-analysis of the non-randomized reports in the treatment of recurrent CRC showed improved 5-year overall survival after IORT [29]. Moreover, better local control with a lower risk of relapse at higher doses of radiation have been reported with the use of IORT [5,11].…”

“…The most common types of early postoperative complications are those associated with wound healing 3-46% and pelvic abscesses, intestinal obstructions and fistulas [17,20,22,29,32,37]. Postoperative complications vary from 15% to 68% [38].…”

In vivodosimetry using Gafchromic films during pelvic intraoperative electron radiation therapy (IOERT)

“…International guidelines recommend prescription to the 90% isodose for adequate tumour coverage, but give no indications of acceptable uncertainties. 6 Treatment outcomes have been assessed in several studies, 7,8 but cannot be correlated with patient-specific dose distributions. In this context, it is necessary to first determine how frequently step-like surfaces occur in clinical practice and how great is the effect of clinically occurring irregularities on the dose distributions.…”

Abdominosacral resection in the surgical treatment of rectal cancer

“…Большинство авторов, описывающих собственный опыт проведения АСР при раке прямой кишки (РПК), указывают, что их пациенты получали те или иные варианты предоперационной и/или интраоперацион-ной лучевой терапии (ЛТ), однако ее режимы часто разнятся [7][8][9].…”