Intraoperative Electron Beam Radiation Therapy (IOERT) Versus High-Dose-Rate Intraoperative Brachytherapy (HDR-IORT) in Patients With an R1 Resection for Locally Advanced or Locally Recurrent Rectal Cancer.

Autor:	Voogt ELK; Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. Electronic address: eva.voogt@catharinaziekenhuis.nl., van Rees JM; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Hagemans JAW; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Rothbarth J; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Nieuwenhuijzen GAP; Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands., Cnossen JS; Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands., Peulen HMU; Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands., Dries WJF; Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands., Nuyttens J; Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Kolkman-Deurloo IK; Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Verhoef C; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Rutten HJT; Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands., Burger JWA; Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2021 Jul 15; Vol. 110 (4), pp. 1032-1043. Date of Electronic Publication: 2021 Feb 07.
DOI:	10.1016/j.ijrobp.2021.02.006
Abstrakt:	Purpose: Intraoperative radiation therapy (IORT), delivered by intraoperative electron beam radiation therapy (IOERT) or high-dose-rate intraoperative brachytherapy (HDR-IORT), may reduce the local recurrence rate in patients with locally advanced and locally recurrent rectal cancer (LARC and LRRC, respectively). The aim of this study was to compare the oncological outcomes between both IORT modalities in patients with LARC or LRRC who underwent a microscopic irradical (R1) resection. Methods: All consecutive patients who received IORT because of an R1 resection of LARC or LRRC between 2000 and 2016 in two tertiary referral centers were included. In LARC, a resection margin of ≤2 mm was considered R1. A resection margin of 0 mm was considered R1 in LRRC. Results: In total, 215 patients with LARC were included, of whom 151 (70%) received IOERT and 64 (30%) received HDR-IORT; in addition, 158 patients with LRRC were included, of whom 112 (71%) received IOERT and 46 (29%) received HDR-IORT. After multivariable analyses, the overall survival was not significantly different between the two IORT modalities. The local recurrence-free survival was significantly longer in patients treated with HDR-IORT, both in LARC (hazard ratio [HR], 0.496; 95% CI, 0.253-0.973; P = .041) and LRRC (HR, 0.567; 95% CI, 0.349-0.920; P = .021). In patients with LARC, major postoperative complications were similar for both IORT modalities (IOERT, 30%; HDR-IORT, 27%), whereas in patients with LRRC, the incidence of major postoperative complications was higher after HDR-IORT (IOERT, 26%; HDR-IORT, 46%). Conclusions: This study showed a significantly better local recurrence-free survival in favor of HDR-IORT in patients with an R1 resection for LARC or LRRC. Optimization of the IOERT technique seems warranted. (Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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