Intraoperative electron beam radiation therapy for recurrent locally advanced rectal or rectosigmoid carcinoma

Article Abstract:

The recurrence of rectal cancer in the local area after surgical resection is an important cause of illness and death in rectal cancer patients. Neither surgery nor standard radiotherapy is particularly effective in treating recurrent rectal cancer, and in the past the role of radiotherapy in relieving pain or bleeding has been palliative (for relief of pain only). This situation is changing, however, as it has become possible to deliver powerful electron beams specifically to the affected area during surgery. The authors report their experience with 39 patients being treated for rectal or rectosigmoid cancer. Although these patients had locally recurrent cancer, they were all free of signs of metastatic disease at the time of surgery. All patients received preoperative radiotherapy, which included 25 doses to a large abdominal field and 3 additional doses to the affected area. During surgery, biopsy specimens were obtained and immediately evaluated to determine which patients were candidates for intraoperative electron beam radiotherapy. Thirty patients received intraoperative electron beam radiation at a dosage dependent upon the size of the residual tumor. Five-year local control was achieved in 26 percent of the 30 patients treated in this way, and 5-year disease-free survival was obtained in 19 percent. The completeness of the surgical resection of the cancerous tissue was the most important factor in determining the patient survival. Among the 13 patients for whom a complete resection was possible, 54 percent remained disease-free at 5 years. However, among the patients for whom the surgical resection was incomplete, only six percent were alive without evidence of disease at five years. Currently, the authors are attempting to improve this rate of disease-free survival with the simultaneous application of chemotherapy during intraoperative electron beam radiotherapy and administration of postoperative radiotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Colorectal cancer, Prognosis, Radiotherapy

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Intraoperative electron beam radiation therapy for retroperitoneal soft tissue sarcoma

Article Abstract:

Sarcomas are any cancer which arises from tissues which began their development in the part of the embryo called the mesoderm. Such tissues include bone, muscle and connective tissue. When sarcomas arise from soft tissues of the arms or legs, the combination of surgery and radiation therapy often proves to be quite effective. However, the treatment is complicated when a sarcoma arises behind the abdominal cavity. It is often more difficult to surgically remove the entire area through which the tumor has spread. Furthermore, the dose of radiation that can be administered is limited by the low tolerance for radiation of the healthy organs in the area, such as the stomach and intestines. This problem may be circumvented somewhat through the application of intraoperative electron beam radiation (IORT) therapy. In contrast with external beam radiation therapy, IORT is administered directly to the affected area during the surgical procedure itself. Therefore, unwanted exposure of adjacent organs may be prevented in a way not possible when the radiation must pass clear through the patient. This method was used in the treatment of 12 patients without known metastatic disease. Complete surgical removal of the tumor was possible in 10 cases, and partial removal was accomplished in two. Eight of the 12 patients remain alive without evidence of disease. Two of the patients who died developed extensive recurrence in the area of the original tumor and two died of metastatic disease spread to distant areas of the body. The results indicate that the combination of aggressive surgical procedures combined with radiation therapy may provide satisfactory control of retroperitoneal soft-tissue sarcoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, Intraoperative radiotherapy

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Case 18-2004: A 61-year-old man with rectal bleeding and a 2-cm mass in the rectum

Article Abstract:

A case study of 61-year-old man suffering from low rectal adenocarcinoma, admitted to the Massachusetts General Hospital, is presented. The findings of a digital rectal examination suggest a mobile, 2-cm soft mass low in the left lateral portion of the rectum.

United States, Care and treatment, Case studies, Gastrointestinal bleeding, Gastrointestinal hemorrhage

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