title: Intraoperative pelvic brachytherapy for treatment of locally advanced or recurrent colorectal cancer.
abstract: BACKGROUND
  The aim of this study was to evaluate the efficacy and morbidity of intraoperative radiation therapy (IORT) for advanced colorectal cancer.
  
  
  METHODS
  All patients undergoing IORT for locally advanced rectal cancer from 2001-2009 were reviewed for cancer recurrence, survival, and procedure-related morbidity. Cumulative event rates were estimated using the method of Kaplan and Meier.
  
  
  RESULTS
  Twenty-nine patients with locally advanced (n = 8) or recurrent (n = 21) rectal cancers were treated with IORT and resection. Surgical interventions included low anterior resection, abdominoperineal resection, pelvic exenteration, and a variety of non-anatomic resections of pelvic recurrences. R(0) resections were achieved in 16 patients, while R(1) resections were achieved in 10, and margins were grossly positive in 3 patients. IORT was delivered to all patients over a median area of 48 (42-72) cm(2) at a median dose of 12 (12-15) Gy. Local and overall recurrence rates were 24 % (locally advanced group) and 45 % (recurrent group). Median disease-free and overall survival were 25 and 40 months respectively at a median follow-up of 26 (18-42) months. The short-term (≤30 days) complication rate was 45 %. Eight patients developed local wound complications, 5 of which required operative intervention. Four patients developed intra-abdominal abscesses requiring drainage. Long-term (>30 days) complications were identified in 11 patients (38 %) and included long-term wound complications (n = 3), ureteral obstruction requiring stenting (n = 1), neurogenic bladder (n = 3), enteric fistulae (n = 2), small bowel obstruction (n = 1), and neuropathic pain (n = 1).
  
  
  CONCLUSIONS
  Intraoperative brachytherapy is a viable IORT option during pelvic surgery for locally advanced or recurrent colorectal cancer but is associated with high postoperative morbidity. Whether intraoperative brachytherapy can improve local recurrence rates for locally advanced or recurrent colorectal cancer will require further prospective investigation.
authors.affiliation: Department of General Surgery, Duke University Medical Center, DUMC 2817, Durham, NC, 27710, USA. ryan.turley@duke.edu
authors.forename: R S
authors.initials: RS
authors.lastname: Turley
authors.forename: B G
authors.initials: BG
authors.lastname: Czito
authors.forename: J C
authors.initials: JC
authors.lastname: Haney
authors.forename: D S
authors.initials: DS
authors.lastname: Tyler
authors.forename: C R
authors.initials: CR
authors.lastname: Mantyh
authors.forename: J
authors.initials: J
authors.lastname: Migaly
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D002277:Carcinoma / Q000532:radiotherapy* / Q000601:surgery; D015179:Colorectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D017577:Cutaneous Fistula / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D007415:Intestinal Obstruction / Q000209:etiology; D007430:Intraoperative Care; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery; D009437:Neuralgia / Q000209:etiology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*; D014517:Ureteral Obstruction / Q000209:etiology; D001750:Urinary Bladder, Neurogenic / Q000209:etiology; D014624:Vaginal Fistula / Q000209:etiology