Recurrences of XXXX : results of a multimodal approach with intraoperative radiation therapy. French Group of IORT. Intraoperative Radiation Therapy.

@entity1 @entity5 @entity3 @entity204 @entity1487
PURPOSE: Prognosis of recurrent @entity5 remains poor, mainly because of the difficulties of achieving a satisfactory local control. Intraoperative radiation therapy (IORT) allows for the delivery of a complementary single dose to the @entity5 residues or to the @entity5 bed and could be useful jn a multimodal treatment. In an attempt to evaluate this interest, a retrospective analysis of @entity1 treated with IORT in six French hospitals has been performed. METHODS AND MATERIALS: Data have been collected in 73 @entity1 (41 @entity1 ), with a mean age of 62 years, treated with IORT. @entity5 were large (mean diameter: 45 mm), partially or totally fixed to the contiguous structures in 39%, and with nodal involvement in 50% of the cases. Initial surgery had been a sphincter-sparing surgery in 67%; external radiation therapy had been delivered in 52%, and a chemotherapy had been given in 10% of the @entity1 . Recurrences were isolated (without @entity3 ) in 86%, and were posterior or posterolateral in 55% of the cases. Surgery allowed for a complete macroscopical resection in 57%, a partial resection with gross residual disease in 29%, and no resection in 14% of the recurrences. Intraoperative radiation therapy was delivered in a dose of 10 to 25 Gy (mean 18.5) through localizators of a mean diameter of 75 mm (60 to 110). External radiation therapy, either preoperative or postoperatively was given to 30 @entity1 without prior radiation therapy. Ten @entity1 received additional chemotherapy with @entity1487 . RESULTS: Four postoperative @entity204 occurred. Postoperative morbidity occurred in 16 @entity1 and some complications were probably related to the IORT procedure. Four long-term complications were observed. Overall actuarial survival occurred in 72.4% of the @entity1 at 1 year, in 44.6% at 2 years, and in 30.6% at 3 years. Twenty-one local failures have been observed. Actuarial local control occurred in 71.3% of the @entity1 at 1 year, 47.7% at 2 years, and 31.3% at 3 years. CONCLUSION: Intraoperative radiation therapy is a complementary treatment for recurrences of @entity5 . It provides encouraging results, particularly in some selected situations, when @entity1 have not previously been treated with external radiation therapy. Further studies of multimodal treatments are necessary.
