The role of intraoperative radiotherapy in advanced rectal cancer: a meta‐analysis

Fahy, Matthew; Kelly, Michael E.; Foley, Megan Power; Nugent, Timothy; Shields, Conor; Winter, D. C.

doi:10.1111/codi.15698

Cited by 14 publications

(5 citation statements)

References 41 publications

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“…Most of the challenges in the treatment of rectal cancer concern the lowest located and the locally advanced tumors. Several reports have described the availability and effectiveness of IOeRT combined with preoperative chemoradiation for controlling LARC [ 12 ] and promoting improved local control results compared to non-IOeRT strategies based on systematic reviews [ 13 , 14 ]. In particular, the data reported in cT4 patients and isolated recurrences, using IOeRT as a component of local intensification treatments [ 15 , 16 ], are incorporated in the experts’ guidelines as a component of the multimodal treatment that is recommended in clinical practice [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development

et al. 2022

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Background Local cancer therapy by combining real-time surgical exploration and resection with delivery of a single dose of high-energy electron irradiation entails a very precise and effective local therapeutic approach. Integrating the benefits from minimally invasive surgical techniques with the very precise delivery of intraoperative electron irradiation results in an efficient combined modality therapy. Methods Patients with locally advanced disease, who are candidates for laparoscopic and/or thoracoscopic surgery, received an integrated multimodal management. Preoperative treatment included induction chemotherapy and/or chemoradiation, followed by laparoscopic surgery and intraoperative electron radiation therapy. Results In a period of 5 consecutive years, 125 rectal cancer patients were treated, of which 35% underwent a laparoscopic approach. We found no differences in cancer outcomes and tolerance between the open and laparoscopic groups. Two esophageal cancer patients were treated with IOeRT during thoracoscopic resection, with the resection specimens showing intense downstaging effects. Two oligo-recurrent prostatic cancer patients (isolated nodal progression) had a robotic-assisted surgical resection and post-lymphadenectomy electron boost on the vascular and lateral pelvic wall. Conclusions Minimally invasive and robotic-assisted surgery is feasible to combine with intraoperative electron radiation therapy and offers a new model explored with electron-FLASH beams.

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Section: Discussionmentioning

confidence: 99%

Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development

et al. 2022

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“…They reported a nonsignificant decrease in locoregional recurrence (14.7% vs. 21.4%, P = 0.11), with no significant increase in overall complication rate (36.3% vs. 28.6%) with IORT. 50 Mirnezami et al found a higher rate of postoperative wound complications with IORT, although no differences in ureter injury or anastomotic complications were detected. 48…”

Section: Intraoperative Radiation Therapymentioning

confidence: 96%

“…A similarly designed meta-analysis by Fahy et al included many of the same studies, with over 800 patients with locally advanced or recurrent rectal cancer treated with IORT versus surgery/EBRT. They reported a nonsignificant decrease in locoregional recurrence (14.7% vs. 21.4%, P = 0.11), with no significant increase in overall complication rate (36.3% vs. 28.6%) with IORT 50 . Mirnezami et al found a higher rate of postoperative wound complications with IORT, although no differences in ureter injury or anastomotic complications were detected 48 …”

Section: Principles Of Radiation Therapymentioning

confidence: 97%

Treatment of Locally Recurrent Rectal Cancer

Regan,

Hendren,

Krauss

et al. 2024

Cancer J

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Up to 10% of patients with locally advanced rectal cancer will experience locoregional recurrence. In the setting of prior surgery and often radiation and chemotherapy, these represent uniquely challenging cases. When feasible, surgical resection offers the best chance for oncologic control yet risks significant morbidity. Studies have consistently indicated that a negative surgical resection margin is the strongest predictor of oncologic outcomes. Chemoradiation is often recommended to increase the chance of an R0 resection, and in cases of close/positive margins, intraoperative radiation/brachytherapy can be utilized. In patients who are not surgical candidates, radiation can provide symptomatic relief. Ongoing phase III trials are aiming to address questions regarding the role of reirradiation and induction multiagent chemotherapy regimens in this population.

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“…Fahy et al from Ireland published a meta-analysis in 2021 examining the role of IORT as part of the multimodality treatment of both locally advanced and locally recurrent rectal cancers. 22 They included patients treated from 2000 to 2020 treated with surgery/EBRT with or without IORT with a primary endpoint of LR. Seven papers met the criteria for inclusion.…”

Section: Iort Processmentioning

confidence: 99%

The Role of Intraoperative Radiotherapy Treatment of Locally Advanced Rectal Cancer

Amarnath

2023

Clin Colon Rectal Surg

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Intraoperative radiation therapy (IORT) has been used in the treatment of locally advanced and recurrent rectal cancers for the last several decades. Given the heterogeneity of patients treated and different indications for use and dosing at different institutions, it has been difficult to discern if IORT adds any appreciable benefit to standard of care therapies. Herein, the rationale for IORT in rectal cancer is discussed along with the most modern and best available data in 2023. IORT is likely indicated in patients with locally advanced and locally recurrent rectal cancer with threatened margins (R0 or R1 resection) to help improve local control. High-quality imaging and multidisciplinary discussion are necessary to ensure optimal patient selection. Appropriate counseling of the patient and excellent team communication are of the utmost importance given the challenging nature of these cases and the prognostic implications of R1 and R2 resections in this patient population.

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The role of intraoperative radiotherapy in advanced rectal cancer: a meta‐analysis

Cited by 14 publications

References 41 publications

Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development

Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development

Treatment of Locally Recurrent Rectal Cancer

The Role of Intraoperative Radiotherapy Treatment of Locally Advanced Rectal Cancer

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