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Il Giornale di Chirurgia

Trattamento del carcinoma del retto localmente avanzato mediante chemio-radioterapia preoperatoria in combinazione con radioterapia intraoperatoria (IORT)

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Object: The use of aggressive multimodality treatment including preoperative chemo-radiation, surgery, and intraoperative radiotherapy (IORT) has been shown to impact on relapse and survival in patients with unresectable and recurrent rectal cancer. The aim of this study was to determine the outcome of this approach in locally advanced primary rectal cancer.
Patients and methods: The study cohort comprised 53 patients (38 men and 15 women; median age 65 years, range 40-80) with clinical T3-4NxM0 adenocarcinoma of the rectum who received preoperative chemo-radiation, radical surgery (40 low anterior resection and 13 abdominoperineal resection), and IORT at our Institution between January 2000 and December 2005. Median distance of the tumor from the anal verge was 5 cm (range 2-13). According to the cTNM staging system 13 (25%) of the tumors were cT4 and 13 (25%) were cN positive. Univariate and multivariate analysis for disease free survival (DFS) and overall survival (OS) were performed.
Results: Median follow-up was 54 months (range 10-111), and 5-year DFS and OS were 67,0% and 78,7% respectively. Univariate analysis of survival showed that DFS and OS were 76,7% and 86,7% in patients with cT3 tumors and 38,8% and 55,5% in patients with cT4 tumors (P<0,01). At multivariate analysis of survival cT, cN, and tumor regression grade (TRG) were independent prognostic factors. Postoperative morbidity and mortality rate were 33,9% and 3,8% respectively.
Conclusions: Multimodality treatment including IORT is highly effective in locally advanced rectal cancer. Due to its toxicity this approach should be balanced with the risk of local recurrence.

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