Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA.
Radiat Oncol. 2012 Jul 20;7:110. doi: 10.1186/1748-717X-7-110.
Patients with locally advanced or recurrent rectal cancer often require multimodality treatment. Intraoperative radiation therapy (IORT) is a focal approach which aims to improve local control.
We retrospectively reviewed 42 patients treated with IORT following definitive resection of a locally advanced or recurrent rectal cancer from 2000-2009. All patients were treated with the Intrabeam® Photon Radiosurgery System (PRS). A dose of 5 Gy was prescribed to a depth of 1 cm (surface dose range: 13.4-23.1, median: 14.4 Gy). Median survival times were calculated using Kaplan-Meier analysis.
Of 42 patients, 32 had recurrent disease (76%) while 10 had locally advanced disease (24%). Eighteen patients (43%) had tumors fixed to the sidewall. Margins were positive in 19 patients (45%). Median follow-up after IORT was 22 months (range 0.2-101). Median survival time after IORT was 34 months. The 3-year overall survival rate was 49% (43% for recurrent and 65% for locally advanced patients). Local recurrence was evaluable in 34 patients, of whom 32% failed. The 1-year local recurrence rate was 16%. Distant metastasis was evaluable in 30 patients, of whom 60% failed. The 1-year distant metastasis rate was 32%. No intraoperative complications were attributed to IORT. Median duration of IORT was 35 minutes (range: 14-39). Median discharge time after surgery was 7 days (range: 2-59). Hydronephrosis after IORT occurred in 10 patients (24%), 7 of whom had documented concomitant disease recurrence.
The Intrabeam® PRS appears to be a safe technique for delivering IORT in rectal cancer patients. IORT with PRS marginally increased operative time, and did not appear to prolong hospitalization. Our rates of long-term toxicity, local recurrence, and survival rates compare favorably with published reports of IORT delivery with other methods.
局部晚期或复发性直肠癌患者通常需要多模式治疗。术中放疗（IORT）是一种旨在提高局部控制率的焦点治疗方法。
我们回顾性分析了 2000 年至 2009 年间接受局部晚期或复发性直肠癌根治性切除术后接受 IORT 治疗的 42 例患者。所有患者均采用 Intrabeam®光子放射外科系统（PRS）治疗。处方剂量为 5Gy，深度为 1cm（表面剂量范围：13.4-23.1，中位数：14.4Gy）。采用 Kaplan-Meier 分析计算中位生存时间。
42 例患者中，32 例（76%）为复发性疾病，10 例（24%）为局部晚期疾病。18 例（43%）患者肿瘤紧贴侧腹壁。19 例（45%）患者边缘阳性。IORT 后中位随访时间为 22 个月（0.2-101 个月）。IORT 后中位生存时间为 34 个月。3 年总生存率为 49%（复发性患者为 43%，局部晚期患者为 65%）。34 例患者可评估局部复发，其中 32%复发。1 年局部复发率为 16%。30 例患者可评估远处转移，其中 60%转移。1 年远处转移率为 32%。无术中并发症归因于 IORT。IORT 中位时间为 35 分钟（14-39 分钟）。术后中位出院时间为 7 天（2-59 天）。IORT 后发生 10 例（24%）患者肾积水，其中 7 例有明确的伴发疾病复发。
Intrabeam®PRS 似乎是直肠癌患者实施 IORT 的一种安全技术。PRS 行 IORT 略微增加了手术时间，但似乎没有延长住院时间。我们的长期毒性、局部复发率和生存率与其他方法报道的 IORT 结果相当。
