Department of General Surgery, Duke University Medical Center, DUMC 2817, Durham, NC, 27710, USA.
Tech Coloproctol. 2013 Feb;17(1):95-100. doi: 10.1007/s10151-012-0892-8. Epub 2012 Sep 18.
The aim of this study was to evaluate the efficacy and morbidity of intraoperative radiation therapy (IORT) for advanced colorectal cancer.
All patients undergoing IORT for locally advanced rectal cancer from 2001-2009 were reviewed for cancer recurrence, survival, and procedure-related morbidity. Cumulative event rates were estimated using the method of Kaplan and Meier.
Twenty-nine patients with locally advanced (n = 8) or recurrent (n = 21) rectal cancers were treated with IORT and resection. Surgical interventions included low anterior resection, abdominoperineal resection, pelvic exenteration, and a variety of non-anatomic resections of pelvic recurrences. R(0) resections were achieved in 16 patients, while R(1) resections were achieved in 10, and margins were grossly positive in 3 patients. IORT was delivered to all patients over a median area of 48 (42-72) cm(2) at a median dose of 12 (12-15) Gy. Local and overall recurrence rates were 24 % (locally advanced group) and 45 % (recurrent group). Median disease-free and overall survival were 25 and 40 months respectively at a median follow-up of 26 (18-42) months. The short-term (≤30 days) complication rate was 45 %. Eight patients developed local wound complications, 5 of which required operative intervention. Four patients developed intra-abdominal abscesses requiring drainage. Long-term (>30 days) complications were identified in 11 patients (38 %) and included long-term wound complications (n = 3), ureteral obstruction requiring stenting (n = 1), neurogenic bladder (n = 3), enteric fistulae (n = 2), small bowel obstruction (n = 1), and neuropathic pain (n = 1).
Intraoperative brachytherapy is a viable IORT option during pelvic surgery for locally advanced or recurrent colorectal cancer but is associated with high postoperative morbidity. Whether intraoperative brachytherapy can improve local recurrence rates for locally advanced or recurrent colorectal cancer will require further prospective investigation.
本研究旨在评估术中放疗（IORT）治疗局部晚期结直肠癌的疗效和发病率。
回顾 2001 年至 2009 年间接受 IORT 治疗的局部晚期直肠腺癌患者，以评估癌症复发、生存和与手术相关的发病率。采用 Kaplan-Meier 法估计累积事件发生率。
29 例局部晚期（n=8）或复发（n=21）直肠腺癌患者接受 IORT 联合切除术治疗。手术干预包括低位前切除术、腹会阴联合切除术、盆腔切除术和各种非解剖性盆腔复发切除术。16 例患者达到 R0 切除，10 例患者达到 R1 切除，3 例患者边缘大体阳性。所有患者 IORT 照射面积中位数为 48（42-72）cm2，中位数剂量为 12（12-15）Gy。局部和总体复发率分别为 24%（局部晚期组）和 45%（复发组）。中位无病生存期和总生存期分别为 25 个月和 40 个月，中位随访时间为 26（18-42）个月。短期（≤30 天）并发症发生率为 45%。8 例患者发生局部伤口并发症，其中 5 例需要手术干预。4 例患者发生腹腔脓肿，需引流。11 例患者（38%）发生长期（>30 天）并发症，包括长期伤口并发症（n=3）、输尿管支架置入引起的梗阻（n=1）、神经性膀胱（n=3）、肠瘘（n=2）、小肠梗阻（n=1）和神经性疼痛（n=1）。
术中近距离放疗是局部晚期或复发性结直肠癌盆腔手术中一种可行的 IORT 选择，但术后发病率较高。术中近距离放疗是否能降低局部晚期或复发性结直肠癌的局部复发率，还需要进一步的前瞻性研究。
