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Intraoperative RT Valuable Alternative to EBRT for Locally Advanced Rectal Cancer

Findings from a retrospective study posit intraoperative radiotherapy (IORT) as a valuable treatment option for patients with locally advanced rectal cancer unable to receive external-beam radiotherapy (EBRT; Radiat Oncol. 2020 Jan 10. Epub ahead of print).

“[Neoadjuvant EBRT] with concomitant chemotherapy is the current standard-of-care for locally-advanced rectal cancer….[IORT] is to date only recommended for pelvic recurrences or incompletely resectable tumors,” said Sergey Potemin, MD, PhD, Department of Colorectal Surgery, Regional Oncological Center of Krasnodar, Russia, and colleagues.

Thus, Dr Potemin et al retrospectively analyzed data for patients with locally advanced rectal cancer who underwent surgery at a cancer center in Krasnodar and had IORT because of limited access to EBRT.

“Factors of interest were tumor stage, tumor differentiation, resection status, surgery type and neoadjuvant or adjuvant chemotherapy,” explained Dr Potemin and co-investigators, who evaluated local progression-free survival (PFS), PFS, and overall survival (OS).

Among 172 patients (median age, 65 years) included in the analysis, 92 (53.5%) received IORT alone (median dose, 15 Gy) and 80 (46.5%) received neoadjuvant EBRT (median dose, 50.4 Gy) and IORT (median dose, 15 Gy).

Follow-up lasted for a median of 23 months, and toxicity was low in recipients of IORT with or without EBBRT, with an overall complication rate of 5.4%.

At 4 years, the local PFS rates were comparable, with 59.4% in the IORT arm and 65.4% in the IORT plus EBRT arm (P = .70). Likewise, no difference was observed in OS or PFS (P = .66 and P = .51, respectively).

“IORT is a valuable option for patients with locally-advanced rectal cancer in the absence of access to EBRT,” Dr Potemin and colleagues concluded.—Hina Porcelli

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