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Preoperative irradiation for tethered rectal carcinoma
C G Willett1, P C Shellito, G V Rodkey
1Radiation Medicine Service, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston 02114.
Summary
Preoperative external beam radiation therapy (EBRT) and surgery offer moderate survival for tethered rectal cancers. However, local failures persist in unresectable tumor areas, suggesting a need for improved local control strategies.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Tethered rectal carcinomas pose challenges for complete surgical resection.
- Preoperative irradiation (EBRT) is a standard approach for locally advanced rectal cancer.
- Local recurrence remains a concern in patients with tumor adherence to vital structures.
Purpose of the Study:
- To evaluate the efficacy of preoperative EBRT and surgical resection in patients with resectable but tethered rectal carcinomas.
- To identify patterns of failure in this patient cohort.
- To explore the rationale for incorporating intraoperative radiation therapy (IORT) for improved local control.
Main Methods:
- A cohort of 28 patients with resectable, tethered rectal carcinomas underwent preoperative EBRT followed by surgical resection.
- Disease-free survival and local control rates were assessed using actuarial methods.
- Patterns of failure, including local recurrence and distant metastasis, were analyzed.
Main Results:
- The 5-year actuarial disease-free survival rate was 66%, and the local control rate was 76%.
- Local failures (n=4) occurred exclusively in areas of tumor adherence to unresectable structures (sacrum, pelvic sidewall).
- Distant metastases were observed in 6 patients (2 concurrent with local failure).
Conclusions:
- Despite preoperative EBRT and resection, tethered rectal tumors remain at risk for local failure.
- Intraoperative radiation therapy (IORT) boost to areas of tumor adherence is proposed as a strategy to enhance local control in this high-risk group.