Long-term results of intraoperative presacral electron boost radiotherapy (IOERT) in combination with total mesorectal excision (TME) and chemoradiation in patients with locally advanced rectal cancer.
BACKGROUND
We analyzed the long-term results of patients with locally advanced rectal cancer using a multimodal approach consisting of total mesorectal excision (TME), intraoperative electron-beam radiation therapy (IOERT), and pre- or postoperative chemoradiation (CRT).


METHODS
Between 1991 and 2003, 210 patients with locally advanced rectal cancer (65 International Union Against Cancer [UICC] Stage II, 116 UICC Stage III, and 29 UICC Stage IV cancers) were treated with TME, IOERT, and preoperative or postoperative CHT. A total of 122 patients were treated postoperatively; 88 patients preoperatively. Preoperative or postoperative fluoropyrimidine-based CRT was applied in 93% of these patients.


RESULTS
Median age was 61 years (range, 26-81). Median follow-up was 61 months. The 5-year actuarial overall survival (OS), disease-free survival (DFS), local control rate (LC), and distant relapse free survival (DRS) of all patients was 69%, 66%, 93%, and 67%, respectively. Multivariate analysis revealed that UICC stage and resection status were the most important independent prognostic factors for OS, DFS, and DRS. The resection status was the only significant factor for local control. T-stage, tumor localization, type of resection, and type of chemotherapy had no significant impact on OS, DFS, DRS, and LC. Acute and late complications > or =Grade 3 were seen in 17% and 13% of patients, respectively.


CONCLUSIONS
Multimodality treatment with TME and IOERT boost in combination with moderate dose pre- or postoperative CRT is feasible and results in excellent long-term local control rates in patients with intermediate to high-risk locally advanced rectal cancer.
Krempien
Robert
R
Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. robert_krempien@med.uni-heidelberg.de
Roeder
Falk
F
Oertel
Susanne
S
Roebel
Marianne
M
Weitz
Jürgen
J
Hensley
Frank W
FW
Timke
Carmen
C
Funk
Angela
A
Bischof
Marc
M
Zabel-Du Bois
Angelika
A
Niethammer
Andreas G
AG
Eble
Michael J
MJ
Buchler
Markus W
MW
Treiber
Martina
M
Debus
Jürgen
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D019583:Dose Fractionation, Radiation; D004358:Drug Therapy / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007430:Intraoperative Care / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011882:Radiotherapy, High-Energy / Q000401:mortality*; D012004:Rectal Neoplasms / Q000401:mortality* / Q000628:therapy*; D012447:Sacrum; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome