La radioterapia intraoperatoria (IORT) nel trattamento del cancro del retto

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G.B. DOGLIETTO, C. RATTO, V. VALENTINI

Ann. Ital. Chir., LXXII, 5, 2001

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Background: Local recurrence remains one of the most complex problem in the management of rectal carcinoma. Often, surgery alone is not able to prevent local recurrence development, particularly in locally advanced cancer. A better local control is obtained using the association with radiotherapy and chemotherapy. Intraoperative Radiation Therapy (IORT) represents an innovative therapeutic modality. Patients and methods: 141 patients, 97 with “high risk” cancer (T2N1-2 or T3N0-2) and 44 with “locally advanced” tumor (T3N3, T4N0-3 or local recurrence). 64 patients with extraperitoneal “high risk” rectal cancer have been treated with preoperative radiotherapy (38 Gy), surgical excisio and IORT (10 Gy). In other 33 “high risk” cases, preoperative radio- (50.4 Gy) chemotherapy (Tomudex 2-3 mg), surgery and IORT (10 Gy) have been given. Fourty four patients with “locally advanced” rectal tumor have had external radiotherapy (48 Gy) + chemotherapy (5FU + Mitomicin C) preoperatively, surgery, IORT (10-15 Gy) and chemothe – rapy (5FU + Levamisolo) postoperatively.
Results: Among “high risk” patients, 52-83% of cases havehad a sphincter-saving surgical procedure, 5-year local con – trol is 93%, 5-year overall survival 80%, and 5-year disease free survival 77%. In 50-60% of “high risk” tumors treated with preoperative chemo-radiotherapy the pathologic staging have found a T0-1 tumor. Among “locally advanced” primary tumors, 5-year local control is 90.9%, 5-year disease free survival 47.1%, 5-year overall survival 60.7%. Among patients treated for local recurrence, in 60% a complete tumor resection has been performed; 5-year local con – trol is 79.5%, 5-year disease free survival 19.4%, 5-year overall survival 41.4%. Conclusions: Integrated treatment with radiotherapy, che – motherapy, surgery and IORT has allowed a good local con – trol and seems prolong survival also.