Volume 109, Issue 7 pp. 652-658

Research Article

Intraoperative radiation therapy for locally advanced primary and recurrent colorectal cancer: Ten-year institutional experience

John R. Hyngstrom MD,

John R. Hyngstrom MD

Section of Surgical Oncology, Department of Surgery, University of Utah, Salt Lake City, Utah

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Ching-Wei D. Tzeng MD,

Ching-Wei D. Tzeng MD

Section of Surgical Oncology, Department of Surgery, University of Kentucky, Lexington, Kentucky

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Sam Beddar PhD,

Sam Beddar PhD

Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Prajnan Das MD, MPH,

Prajnan Das MD, MPH

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Sunil Krishnan MD,

Sunil Krishnan MD

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Marc E. Delclos MD,

Marc E. Delclos MD

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Christopher H. Crane MD,

Christopher H. Crane MD

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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George J. Chang MD, MPH,

George J. Chang MD, MPH

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Y. Nancy You MD, MHSc,

Y. Nancy You MD, MHSc

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Barry W. Feig MD,

Barry W. Feig MD

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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John M. Skibber MD,

John M. Skibber MD

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Miguel A. Rodriguez-Bigas MD,

Corresponding Author

Miguel A. Rodriguez-Bigas MD

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

Correspondence to: Miguel A. Rodriguez-Bigas, MD, Department of Surgical Oncology, Unit 1484, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030.

Fax: +713-745-5235. E-mail: [email protected]

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John R. Hyngstrom MD,

John R. Hyngstrom MD

Section of Surgical Oncology, Department of Surgery, University of Utah, Salt Lake City, Utah

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Ching-Wei D. Tzeng MD,

Ching-Wei D. Tzeng MD

Section of Surgical Oncology, Department of Surgery, University of Kentucky, Lexington, Kentucky

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Sam Beddar PhD,

Sam Beddar PhD

Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Prajnan Das MD, MPH,

Prajnan Das MD, MPH

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Sunil Krishnan MD,

Sunil Krishnan MD

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Marc E. Delclos MD,

Marc E. Delclos MD

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Christopher H. Crane MD,

Christopher H. Crane MD

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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George J. Chang MD, MPH,

George J. Chang MD, MPH

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Y. Nancy You MD, MHSc,

Y. Nancy You MD, MHSc

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Barry W. Feig MD,

Barry W. Feig MD

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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John M. Skibber MD,

John M. Skibber MD

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Miguel A. Rodriguez-Bigas MD,

Corresponding Author

Miguel A. Rodriguez-Bigas MD

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

Correspondence to: Miguel A. Rodriguez-Bigas, MD, Department of Surgical Oncology, Unit 1484, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030.

Fax: +713-745-5235. E-mail: [email protected]

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First published: 10 February 2014

https://doi.org/10.1002/jso.23570

Citations: 49

Conflict of interest: none.

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ABSTRACT

Background

We evaluated the role of intraoperative radiation therapy (IORT) during radical resection of locally advanced colorectal cancer (CRC).

Methods

We retrospectively evaluated all patients with CRC treated with IORT at our institution from 2001 to 2010. IORT was delivered using high-dose-rate brachytherapy (median 12.5-Gy). We analyzed factors associated with postoperative morbidity, local control (LC), and overall survival (OS).

Results

One hundred patients were evaluated with 70% received IORT for recurrent tumors. R0 resection rate was 58%. Postoperative Grade ≥3 complications (33%) were independently associated with transfusions ≥3 units packed red blood cells (P = 0.016) and body mass index (BMI) ≥35 (P = 0.0499). Eighty-two patients underwent external beam radiation therapy (EBRT) before IORT. Five-year LC was 94%, for primary and 56%, for recurrent tumors, respectively (P = 0.007). Microscopic positive (R1) margins were not associated with LC (P = 0.316). BMI ≥30 (P = 0.048) and post-discharge complications (P = 0.041) were independent risk factors for worse LC. Median post-IORT OS was 67.7 (95% CI 51.1–84.3) months for all patients.

Conclusion

For patients with primary or recurrent locally advanced CRC, treatment with radical surgery and IORT achieved excellent LC outcomes irrespective of microscopic margin status. IORT may be indicated for tumors suspected to have close or positive microscopic margins. J. Surg. Oncol 2014; 109:652–658. © 2014 Wiley Periodicals, Inc.

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Volume109, Issue7

June 1, 2014

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Intraoperative radiation therapy for locally advanced primary and recurrent colorectal cancer: Ten-year institutional experience

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Intraoperative radiation therapy for locally advanced primary and recurrent colorectal cancer: Ten-year institutional experience

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