Abstract
Background
Short course radiation-based total neoadjuvant therapy can improve disease-free survival
for patients with high-risk locally advanced rectal cancer. Tumors that involve or
threaten the circumferential resection margin have a particularly high risk of local
recurrence. Intraoperative radiation therapy enables treatment escalation at the threatened
or involved margin at the time of surgery.
Patients and Methods
Patients with rectal adenocarcinoma treated with preoperative short course radiotherapy-based
total neoadjuvant therapy and intraoperative radiation at the time of surgery were
identified. All patients had a threatened or involved circumferential resection margin
on magnetic resonance imaging at the time of diagnosis. Treatment details, radiation
toxicities, postoperative complications and oncologic outcomes were recorded.
Results
Ten patients received intraoperative radiation after short course radiation-based
total neoadjuvant therapy. All patients had an involved or threatened circumferential
resection margin, 60% had extramural venous invasion, and 60% had positive lateral
pelvic lymph nodes. Seven patients had negative surgical margins (≥ 2 mm), and 3 patients
had an R1 resection with radial margins < 2 mm. The median [IQR] length of hospitalization
after surgery was 11 [7-14] days. Three patients required readmission and 2 patients
required reoperation due to complications including anastamotic leak and abscess.
With a median follow up of 19.5 months postoperatively, no patient developed a pelvic
recurrence, and 6 patients developed distant recurrences.
Conclusions
The use of intraoperative radiation after a short course radiotherapy-based neoadjuvant
therapy is safe and feasible. Further data are needed to determine whether the addition
of intraoperative radiation improves local recurrence rates over preoperative radiation
alone.
Keywords
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Article info
Publication history
Published online: January 07, 2022
Accepted:
January 3,
2022
Received in revised form:
December 30,
2021
Received:
September 4,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
