OC-0488: Surgery and intraoperative radiotherapy for residual or recurrent anal carcinoma after primary chemoradiotherapy
Year: 2013
Type: conference-abstract
Abstract: Purpose/Objective: To report outcomes for patients treated with salvage surgical resection and intraoperative radiotherapy (IORT) for residual or recurrent squamous cell carcinoma (SCC) of the anus after primary chemoradiotherapy (CRT). Materials and Methods:The prospective radiation oncology department IORT database was searched for patients treated with surgery and IORT for anal SCC.Thirty-two patients treated between 1993 and 2012 were identified.All patients had previously received primary concurrent CRT and had residual or recurrent disease based on clinical findings and/or tissue confirmation.All patients with recurrent disease received pre-operative, limited field external beam re-irradiation (median dose 30 Gray) and concurrent chemotherapy.IORT was utilized due to concern that salvage surgery alone would be unlikely to remove all gross and/or microscopic disease.Treatmentrelated adverse events were classified according to the National Cancer Institute -Common Toxicity Criteria Adverse Events (AEs).Overall survival (OS), disease-free survival (DFS), central failure (CF; within the IORT field), local-regional failure (LRF; tumor bed or draining lymphatics), and distant failure (DF) were estimated using the Kaplan-Meier technique.Results: Median age at IORT was 53 years (range 34-87).Twenty-six patients (81%) were female.Salvage treatment was performed for residual disease after CRT (n=9), 1st recurrence after CRT (n=17), or 2nd recurrence after CRT and salvage abdominal-perineal resection (APR, n=6).APR was a component of the multimodality salvage attempt in 22 patients.Extent of surgical resection was R0 (negative margins, n=16), R1 (microscopic residual, n=13), or R2 (macroscopic residual, n=3).IORT was delivered with electron beams (n=31) or highdose rate brachytherapy (n=1).Median IORT dose was 12.5 Gray (range 7.5 -20).Median length of hospital stay was 9 days.Nine patients (28%) were alive at last follow-up.The median follow-up duration was 1.6 years for all patients and 6.3 years for living patients.Mortality at 30 days after surgery and IORT was 0%.Fifteen patients (47%) experienced a total of 16 grade 3 treatment-related AEs.The most common Grade 3 AEs were wound complications (n=6), bowel obstruction (n=5), and ureteral obstruction (n=3).There were no grade 4 or 5 AEs.The 5-year estimates of OS and DFS were 23% and 17%, respectively.The 5-year estimates of CF, LRF, and DF were 26%, 64%, and 48%, respectively.Conclusions: In this heavily pre-treated, high-risk patient population, aggressive salvage surgery and IORT was associated with long-term survival in a small, but significant subset of patients.
Source: Radiotherapy and Oncology
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,770
OpenAlex ID: W2614128040