Intraoperative irradiation for locally recurrent colorectal cancer in previously irradiated patients
Intraoperative irradiation for locally recurrent colorectal cancer in previously irradiated patients
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DOI：
10.1016/s0360-3016(00)01528-5
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发表时间：
2001-04-01
影响因子：
7
通讯作者：
Wolff, BG
中科院分区：
文献类型：
--
作者：
Haddock, MG;Gunderson, LL;Wolff, BG
目的：文献中关于先前接受过高或中剂量外照射（EBRT）治疗的局部复发性结直肠癌患者的挽救治疗的信息很少。因此，我们机构进行了一项回顾性审查，以确定接受手术切除和术中电子照射 (IOERT) +/- 额外 EBRT 和化疗积极治疗的患者的疾病控制、生存和耐受性。 方法和材料：从 1981 年到 1994 年，51 名既往接受过放射治疗的复发性局部晚期结直肠癌患者，没有远处转移性疾病的证据，在 Mayo Clinic Rochester 接受了手术切除和 IOERT +/- 额外 EBRT 治疗。如果可以安全地完成，我们尝试在 IOERT 之前实现总体切除。中位 IOERT 剂量为 20 Gy（范围：10-30 Gy）。 37 名患者在术前或术后接受了额外的 EBRT，剂量范围为 5 至 50.4 Gy（中位 25.2 Gy）。 20 名患者在 EBRT 期间接受了 5-氟尿嘧啶 +/- 亚叶酸。 3 名患者接受额外周期的 5-氟尿嘧啶 +/- 亚叶酸作为维持化疗。结果：30 名男性和 21 名女性接受治疗，中位年龄为 55 岁（范围 31-73 岁）。三十四名患者死亡；存活患者的中位随访时间为 21 个月。中位、2 年和 5 年精算总生存期分别为 23 个月、48% 和 12%。 2 年精算中央控制（IOERT 领域内）为 72%。 60% 的患者维持了 2 年的局部控制。与未接受 EBRT 或未接受 EBRT 的患者相比，除 IOERT 外还接受大于或等于 30 GS EBRT 的患者有改善局部控制的趋势。
Purpose: Information in the literature regarding salvage treatment for patients with locally recurrent colorectal cancer who have previously been treated with high or moderate dose external beam irradiation (EBRT) is scarce. A retrospective review was therefore performed in our institution to determine disease control, survival, and tolerance in patients treated aggressively with surgical resection and intraoperative electron irradiation (IOERT) +/- additional EBRT and chemotherapy.Methods and Materials: From 1981 through 1994, 51 previously irradiated patients with recurrent locally advanced colorectal cancer without evidence of distant metastatic disease were treated at Mayo Clinic Rochester with surgical resection and IOERT +/- additional EBRT. An attempt was made to achieve a gross total resection before IOERT if it could be safely accomplished. The median IOERT dose was 20 Gy (range, 10-30 Gy). Thirty-seven patients received additional EBRT either pre- or postoperatively with doses ranging from 5 to 50.4 Gy (median 25.2 Gy). Twenty patients received 5-fluorouracil +/- leucovorin during EBRT. Three patients received additional cycles of 5-fluorouracil +/- leucovorin as maintenance chemotherapy.Results: Thirty males and 21 females with a median age of 55 years (range 31-73 years) were treated. Thirty-four patients have died; the median follow up in surviving patients is 21 months. The median, 2-yr, and 5-yr actuarial overall survivals are 23 months, 48% and 12%, respectively. The 2-yr actuarial central control (within IOERT field) is 72%. Local control at 2 years has been maintained in 60% of patients. There is a trend toward improved local control in patients who received greater than or equal to 30 GS EBRT in addition to IOERT as compared to those who received no EBRT or