Alberto Muñoz-Calero

Prognostic Impact of External Beam Radiation Therapy in Patients Treated With and Without Extended Surgery and Intraoperative Electrons for Locally Recurrent Rectal Cancer: 16-Year Experience in a Single Institution

PURPOSE To analyze prognostic factors associated with survival in patients after intraoperative electrons containing resective surgical rescue of locally recurrent rectal cancer (LRRC). METHODS AND MATERIALS From January 1995 to December 2011, 60 patients with LRRC underwent extended surgery (n=38: multiorgan [43%], bone [28%], soft tissue [38%]) or nonextended (n=22) surgical resection, including a component of intraoperative electron-beam radiation therapy (IOERT) to the pelvic recurrence tumor bed. Twenty-eight (47%) of these patients also received external beam radiation therapy (EBRT) (range, 30.6-50.4 Gy). Survival outcomes were estimated by the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. RESULTS The median follow-up time was 36 months (range, 2-189 months), and the 1-year, 3-year, and 5-year rates for locoregional control (LRC) and overall survival (OS) were 86%, 52%, and 44%; and 78%, 53%, 43%, respectively. On multivariate analysis, R1 resection, EBRT at the time of pelvic rerecurrence, no tumor fragmentation, and non-lymph node metastasis retained significance with regard to LRR. R1 resection and no tumor fragmentation showed a significant association with OS after adjustment for other covariates. CONCLUSIONS EBRT treatment integrated for rescue, resection radicality, and not involved fragmented resection specimens are associated with improved LRC in patients with locally recurrent rectal cancer. Additionally, tumor fragmentation could be compensated by EBRT. Present results suggest that a significant group of patients with LRRC may benefit from EBRT treatment integrated with extended surgery and IOERT.

Post-chemoradiation intraoperative electron-beam radiation therapy boost in resected locally advanced rectal cancer: long-term results focused on topographic pattern of locoregional relapse.

BACKGROUND Patients with locally advanced rectal cancer (LARC) have a dismal prognosis. We investigated outcomes and risk factors for locoregional recurrence (LRR) in patients treated with preoperative chemoradiotherapy (CRT), surgery and IOERT. METHODS A total of 335 patients with LARC [⩾cT3 93% and/or cN+ 69%) were studied. In multivariate analyses, risk factors for LRR, IFLR and OFLR were assessed. RESULTS Median follow-up was 72.6 months (range, 4-205). In multivariate analysis distal margin distance ⩽10 mm [HR 2.46, p = 0.03], R1 resection [HR 5.06, p = 0.02], tumor regression grade 1-2 [HR 2.63, p = 0.05] and tumor grade 3 [HR 7.79, p < 0.001] were associated with an increased risk of LRR. A risk model was generated to determine a prognostic index for individual patients with LARC. CONCLUSIONS Overall results after multimodality treatment of LARC are promising. Classification of risk factors for LRR has contributed to propose a prognostic index that could allow us to guide risk-adapted tailored treatment.

Resultados de la cirugía con tratamiento neoadyuvante del cáncer de recto

Resumen Objetivo El tratamiento neoadyuvante en el cancer de recto esta cada vez mas establecido como la forma mas adecuada de complementar la reseccion quirurgica en lesiones localmente avanzadas. Los centros con especial interes en el tratamiento multidisciplinario del cancer de recto evaluan diversas modalidades de tratamiento adyuvante preoperatorio. El presente trabajo es una revision critica de las diversas formas de tratamiento empleadas. Resultados La adyuvancia preoperatoria se tolera de forma aceptable, controla la progresion de la enfermedad, facilita la reseccion de lesiones grandes y, en las localizadas en el tercio inferior, ayuda a la preservacion esfinteriana. Mejora las cifras de recidiva local y aumenta la tasa de supervivencia libre de enfermedad. La tendencia actual es asociar quimioterapia durante la radioterapia, aun cuando el beneficio de esta asociacion debe ser validado por estudios aleatorizados que estan pendientes de resultados. Este tratamiento no esta exento de efectos secundarios, tales como alteracion de la funcion anorrectal y sexual, por lo que debe seleccionarse a los pacientes que se beneficiaran de este esquema terapeutico. Conclusiones El tratamiento neoadyuvante es de eleccion en los pacientes con tumores en estadios II y III. En el futuro, nuevos esquemas y agentes quimioterapicos, y sistemas que sean capaces de identificar a los pacientes con tumores que sean respondedores a estas formas de tratamiento complementario, haran posible un mejor uso de estas opciones terapeuticas.