Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Eur J Surg Oncol. 2012 Oct;38(10):955-61. doi: 10.1016/j.ejso.2012.07.006. Epub 2012 Jul 21.
To evaluate the feasibility and long-term outcome of surgery combined with intraoperative electron radiotherapy (IOERT) as rescue treatment in patients with recurrent and/or metastatic oligotopic extrapelvic cancer.
From April 1996 to April 2010, we treated 28 patients using 34 IOERT procedures. The main histopathology findings were adenocarcinoma (39%) and squamous cell carcinoma (29%). The original cancer sites were gynecologic (67%), urologic (14%) and colorectal (14%). The location of recurrence was the para-aortic region in 53.5% of patients.
Median follow-up was 39 months (1-84 months), during which time 14% of patients experienced local recurrence and 53.5% developed distant metastasis. Overall survival at 2 and 5 years was 57% and 35% respectively. At the time of the analysis, 13 patients were alive, 6 for more than 55 months of follow-up. Local control was not significantly affected by the following histopathologic characteristics of the resected surgical specimen: number of fragments submitted for pathology study (1 to >6), maximal tumor dimension (≤ 2 to ≥ 6 cm), rate of involved nodes (0-100%) and involved resection margin (local recurrence 23% vs 7%; p = 0.21). Local recurrence was significantly affected by microscopic cancer in more than 50% of specimen fragments (38% vs 9%, p = 0.02).
IOERT for recurrence of oligotopic extrapelvic cancer increased long-term survival in patients with controlled cancer and appears to compensate for some adverse prognostic features in local control. Individualized treatment strategies for this heterogeneous category of patients with recurrent cancer will make it possible to optimize results.
评估手术联合术中电子放射治疗（IOERT）作为复发性和/或转移性寡发性盆腔外癌症患者挽救性治疗的可行性和长期结果。
从 1996 年 4 月至 2010 年 4 月，我们使用 34 次 IOERT 治疗了 28 名患者。主要组织病理学发现是腺癌（39%）和鳞状细胞癌（29%）。原始癌症部位为妇科（67%）、泌尿科（14%）和结直肠（14%）。复发部位位于主动脉旁区域的患者占 53.5%。
中位随访时间为 39 个月（1-84 个月），在此期间，14%的患者发生局部复发，53.5%发生远处转移。2 年和 5 年的总生存率分别为 57%和 35%。在分析时，13 名患者存活，其中 6 名患者的随访时间超过 55 个月。局部控制不受以下切除手术标本组织病理学特征的显著影响：提交进行病理研究的标本数量（1 至>6）、最大肿瘤尺寸（≤2 至≥6cm）、阳性淋巴结数量（0-100%）和阳性切缘（局部复发率为 23%对 7%；p=0.21）。局部复发与标本中超过 50%的肿瘤组织学存在显著相关（38%对 9%；p=0.02）。
对于寡发性盆腔外癌症的复发，IOERT 增加了癌症得到控制的患者的长期生存率，并且似乎补偿了局部控制方面的一些不良预后特征。对于复发性癌症的这一异质性患者群体，个体化治疗策略将使优化结果成为可能。
