Cic edizioni internazionali
Il Giornale di Chirurgia

La radioterapia intraoperatoria (IORT) nel carcinoma del retto primitivo e recidivo

Articolo, 63 - 64
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Abstract
Purpose: To verify the impact of IORT (intraoperative radiotherapy) on local control of the tumour and survival in patients with primitive or recurrent cancer of the rectum.
Methods: From 1990 to 2006 we operated on 437 patients with rectal cancer; 75 of these were treated with IORT: 65 had a primitive locally advanced cancer, while 10 had a local recurrence after resection. Patients with primitive cancer were divided in 3 groups: Group I: 18 patients treated with resection + IORT; Group II: 13 patients treated with resection + IORT + postoperative radio/chemotherapy; Group III: 34 patients treated with preoperative radio/chemotherapy + resection + IORT +/- postoperative radio/chemotherapy. Patients with local recurrence after resection formed the Group IV.
Results: Overall survival at 5 years in patients with primitive cancer was 47%, with values of 39% for Group I, 54% for Group II and 68% for Group III. Local recurrence was 8% (17% for Group I, 8% for Group II, 3% for Group III). Perioperative mortality was null. Morbidity was 20%, without complications undoubtedly due to IORT. Only for 5 patients with recurrence (Group IV) was possible to achieve a macroscopically radical resection of the tumour; 8 patients died, with median survival of 18 months.
Conclusions: Our experience suggests that a multi-modal treatment including IORT of primitive locally advanced cancer of the rectum can allow an improvement in local control of the disease, although similar outcome are not so valuable in order to survival. We have not obtained satisfactory results in the treatment of cancer recurrence. However IORT is a safe and well-tolerated treatment, that don’t causes an increase of morbidity and mortality.

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