Locally advanced Rectal cancer and recurrencies

In stage II and III rectal cancer patients with high risk of local recurrence, the evidence brought by studies using IORT confirm its potential controlling the disease. IORT should be performed as a boost application in combination with conventional external radiotherapy and chemotherapy.

To date, over 1100 patients have been treated with this protocol. Of 79 studies reviewed, only 10% have used IORT as exclusive treatment with high doses (> 20Gy).

Usually IORT is delivered in doses of 10-12.5 Gy with microscopic residual, or 15-20 Gy with residue of about 2 cm. The reported survival rate is at 5-year is 43 to 95%.

An Italian study (Doglietto-Valentini) followed 113 patients with colorectal cancer medium-low T3. Patients who underwent surgery alone showed a survival rate of 52.2% at 5 years with a recurrence rate of 23.2%, while those who underwent preoperative chemo radiotherapy and IORT showed a recurrence rate of 6.6% and a 5-year survival of 73%.

A promising and fascinating aspect of IORT technique, of great benefit for the patient's quality of life, lies in the ability to perform the IORT treatment after laparoscopic surgery.

In pelvic recurrences originating from rectal cancer, the risk of residual disease is quite high.

IORT  treatment can help to control local disease, as a the boost dose range between 10 and 20 Gy combined with conventional external beam radiotherapy and chemotherapy.

Studies conducted on this type of combined treatment reported a success of local control in 26-79% among treated patients.