Treatment of locally advanced rectal cancer with external beam radiation, surgical resection, and intraoperative radiation therapy

Tepper, Joel E.; Wood, William C.; Cohen, Alfred M.

doi:10.1016/0360-3016(89)90946-2

Cited by 46 publications

(2 citation statements)

References 9 publications

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“…Since loco-regional recurrence is the most frequent type of failure and will occur in a large group of patients treated for colorectal carcinoma, a frequent and qualified follow-up is indicated in order to secure early detection of recurrences, which can then be subjected to an optimal salvage therapy with radiation/surgery. More aggressive radiation principles may be requested in the form of interoperative radiotherapy, brachytherapy, hyperthermia and/or a combination of these (25)(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

A Randomized Feasibility Study Evaluating the Effect of Radiotherapy Alone Or Combined with 5-Fluorouracil in the Treatment of Locally Recurrent Or Inoperable Colorectal Carcinoma

et al. 1993

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Section: Discussionmentioning

confidence: 99%

A Randomized Feasibility Study Evaluating the Effect of Radiotherapy Alone Or Combined with 5-Fluorouracil in the Treatment of Locally Recurrent Or Inoperable Colorectal Carcinoma

et al. 1993

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“…Adjuvant radiation therapy can reduce the incidence of local recurrence and, therefore, this treatment modality is currently considered as a part of the standard treatment (33). This adjuvant radiation treatment can be given pre-, post-, or intraoperatively (17,34,39,46,47 (Dur. RT = duration of radiation treatment, Hosp = hospitalization stay after surgery and delay between radiotherapy and surgery -delay RT/S -are expressed in days).…”

Section: Discussionmentioning

confidence: 99%

The rationale to switch from postoperative hyperfractionated accelerated radiotherapy to preoperative hyperfractionated accelerated radiotherapy in rectal cancer

Coucke

Sartorelli

Cuttat

et al. 1995

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To demonstrate the feasibility of preoperative Hyperfractionated Accelerated RadioTherapy (preop-HART) in rectal cancer and to explain the rationales to switch from postoperative HART to preoperative HART. Methods and 1989. In trial Materials: Fifty-two consecutive patients were introduced in successive Phase I trials since 89-01. m&operative HART (48 Gv in 3 weeks) was applied in 20 patients. In nine patients with locally advanced rectal cancer, considered unresectable by the surgeon, 32 Gy in 2 weeks was-applied prior to surgery (trial 89-02). Since 1991, 41.6 Gy in 2.5 weeks has been applied preoperatively to 23 patients with T3-T4 any N rectal cancer immediately followed by surgery (trial 91-01). All patients were irradiated at the department of radiation-oncology with a four-field box technique (1.6 Gy twice a day and with at least a 6-h interval between fractions). The minimal accelerating potential was 6 MV. Acute toxicity was scored according to the World Health Organization (WHO for skin and small bowel) and the Radiation Therapy Oncology Group criteria (RTOG for bladder). This was done weekly during treatment and every 3 months thereafter. Small bowel volume was estimated by a modiiied "Gallagher's" method. Results: Acute toxicity was acceptable both in postoperative and preoperative setup. The mean acute toxicity ~significantly lower in trial 91-01 compared to 89-01. This difference was due to the smaller amount of small bowel in irradiation field and lower total dose in trial 91-01. Moreover, there was a significantly reduced delay between surgery and radiotherapy favoring trial 91-01 (median delay 4 days compared to 46 days in trial 89-01). Nearly all patients in trial 89-02 and 91-01 underwent surgery (31 out of 32; 97%). Resection margins were negative in 29 out of 32. Hospitalization duration in trial 91-01 was not significantly different from trial 89-01 (19 vs. 21 days, respectively). Conclusions: Hyperfractionated accelerated radiotherapy immediately followed by surgery is feasible as far as acute toxicity is concerned. Preoperative HART is favored by a significantly lower acute toxicity related, in part, to a smaller amount of irradiated small bowel, and a shorter duration of the delay between radiotherapy and surgery. Moreover, the hospital stay after preoperative HART is not significantly increased.Hyperfractionation, Acceleration, Preoperative radiotherapy, Rectal cancer.

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Results and complications of surgery combined with intra-operative radiation therapy for the treatment of locally advanced or recurrent cancers in the pelvis

Harrison

2000

Semin. Surg. Oncol.

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Intra‐operative radiation therapy (IORT) can benefit patients with pelvic tumors by delivering a high dose of radiation with precise delineation of tumor bed and maximal protection of surrounding normal tissues. The IORT experience has been particularly promising for locally advanced primary or recurrent rectal cancers in which a gross total resection is achieved. However, its potential benefit must be weighed against added toxicity. The main dose‐limiting toxicity of pelvic IORT is peripheral neuropathy and ureteral stenosis. We will review the techniques for optimal IORT delivery, the results of the major studies investigating IORT treatment of rectal cancer, and the pelvic complications associated with combining surgery and IORT. A team of surgeons and radiation oncologists providing close multidisciplinary coordination is essential to integrate IORT with combined modality regimens in a safe and effective manner. Semin. Surg. Oncol. 18:269–278, 2000. © 2000 Wiley‐Liss, Inc.

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Treatment of locally advanced rectal cancer with external beam radiation, surgical resection, and intraoperative radiation therapy

Cited by 46 publications

References 9 publications

A Randomized Feasibility Study Evaluating the Effect of Radiotherapy Alone Or Combined with 5-Fluorouracil in the Treatment of Locally Recurrent Or Inoperable Colorectal Carcinoma

A Randomized Feasibility Study Evaluating the Effect of Radiotherapy Alone Or Combined with 5-Fluorouracil in the Treatment of Locally Recurrent Or Inoperable Colorectal Carcinoma

The rationale to switch from postoperative hyperfractionated accelerated radiotherapy to preoperative hyperfractionated accelerated radiotherapy in rectal cancer

Results and complications of surgery combined with intra-operative radiation therapy for the treatment of locally advanced or recurrent cancers in the pelvis

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