Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignancies
Abstract Background Para-aortic lymph node (PALN) metastases from primary pelvic malignancies are often treated with resection, but recurrence is common. We report toxicity and oncologic outcomes for patients with PALN metastases from gastrointestinal and gynecologic malignancies treated with resect...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-023-02289-2 |
| _version_ | 1797811334751977472 |
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| author | Jacob Hall Jessica Wilson John Shumway Ted K. Yanagihara Joel Tepper Benjamin Calvo Andrew Z. Wang Kevin Pearlstein Kyle Wang Hong Jin Kim |
| author_facet | Jacob Hall Jessica Wilson John Shumway Ted K. Yanagihara Joel Tepper Benjamin Calvo Andrew Z. Wang Kevin Pearlstein Kyle Wang Hong Jin Kim |
| author_sort | Jacob Hall |
| collection | DOAJ |
| description | Abstract Background Para-aortic lymph node (PALN) metastases from primary pelvic malignancies are often treated with resection, but recurrence is common. We report toxicity and oncologic outcomes for patients with PALN metastases from gastrointestinal and gynecologic malignancies treated with resection and intraoperative electron radiotherapy (IORT). Methods We retrospectively identified patients with recurrent PALN metastases who underwent resection with IORT. All patients were included in the local recurrence (LR) and toxicity analyses. Only patients with primary colorectal tumors were included in the survival analysis. Results There were 26 patients with a median follow up of 10.4 months. The rate of para-aortic local control (LC) was 77% (20/26 patients) and the rate of any cancer recurrence was 58% (15/26 patients). Median time from surgery and IORT to any recurrence was 7 months. The LR rate for those with positive/close margins was 58% (7/12 patients) versus 7% (1/14 patients) for those with negative margins (p = 0.009). 15% (4/26 patients) developed surgical wound and/or infectious complications, 8% (2/26 patients) developed lower extremity edema, 8% (2/26 patients) experienced diarrhea, and 19% (5/26 patients) developed an acute kidney injury. There were no reported nerve injuries, bowel perforations, or bowel obstructions. For patients with primary colorectal tumors (n = 19), the median survival (OS) was 23 months. Conclusions We report favorable LC and acceptable toxicity for patients receiving surgical resection and IORT for a population that has historically poor outcomes. Our data show disease control rates similar to literature comparisons for patients with strong risk factors for LR, such as positive/close margins. |
| first_indexed | 2024-03-13T07:22:09Z |
| format | Article |
| id | doaj.art-57f5af2db89449039df65810ea2abdd4 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-03-13T07:22:09Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-57f5af2db89449039df65810ea2abdd42023-06-04T11:35:18ZengBMCRadiation Oncology1748-717X2023-06-011811810.1186/s13014-023-02289-2Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignanciesJacob Hall0Jessica Wilson1John Shumway2Ted K. Yanagihara3Joel Tepper4Benjamin Calvo5Andrew Z. Wang6Kevin Pearlstein7Kyle Wang8Hong Jin Kim9Department of Radiation Oncology, University of North Carolina School of MedicineDepartment of Radiation Oncology, Mayo ClinicDepartment of Radiation Oncology, University of North Carolina School of MedicineDepartment of Radiation Oncology, University of North Carolina School of MedicineDepartment of Radiation Oncology, University of North Carolina School of MedicineDepartment of Surgical Oncology, Roswell Park Cancer InstituteDepartment of Radiation Oncology, University of Texas Southwestern Medical CenterDepartment of Radiation Oncology, University of North Carolina School of MedicineDepartment of Radiation Oncology, University of CincinnatiDivision of Surgical Oncology, Department of Surgery, University of North CarolinaAbstract Background Para-aortic lymph node (PALN) metastases from primary pelvic malignancies are often treated with resection, but recurrence is common. We report toxicity and oncologic outcomes for patients with PALN metastases from gastrointestinal and gynecologic malignancies treated with resection and intraoperative electron radiotherapy (IORT). Methods We retrospectively identified patients with recurrent PALN metastases who underwent resection with IORT. All patients were included in the local recurrence (LR) and toxicity analyses. Only patients with primary colorectal tumors were included in the survival analysis. Results There were 26 patients with a median follow up of 10.4 months. The rate of para-aortic local control (LC) was 77% (20/26 patients) and the rate of any cancer recurrence was 58% (15/26 patients). Median time from surgery and IORT to any recurrence was 7 months. The LR rate for those with positive/close margins was 58% (7/12 patients) versus 7% (1/14 patients) for those with negative margins (p = 0.009). 15% (4/26 patients) developed surgical wound and/or infectious complications, 8% (2/26 patients) developed lower extremity edema, 8% (2/26 patients) experienced diarrhea, and 19% (5/26 patients) developed an acute kidney injury. There were no reported nerve injuries, bowel perforations, or bowel obstructions. For patients with primary colorectal tumors (n = 19), the median survival (OS) was 23 months. Conclusions We report favorable LC and acceptable toxicity for patients receiving surgical resection and IORT for a population that has historically poor outcomes. Our data show disease control rates similar to literature comparisons for patients with strong risk factors for LR, such as positive/close margins.https://doi.org/10.1186/s13014-023-02289-2Intraoperative radiotherapyPara-aortic recurrenceColorectal metastases |
| spellingShingle | Jacob Hall Jessica Wilson John Shumway Ted K. Yanagihara Joel Tepper Benjamin Calvo Andrew Z. Wang Kevin Pearlstein Kyle Wang Hong Jin Kim Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignancies Radiation Oncology Intraoperative radiotherapy Para-aortic recurrence Colorectal metastases |
| title | Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignancies |
| title_full | Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignancies |
| title_fullStr | Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignancies |
| title_full_unstemmed | Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignancies |
| title_short | Outcomes of surgical resection and intraoperative electron radiotherapy for patients with para-aortic recurrences of gastrointestinal and gynecologic malignancies |
| title_sort | outcomes of surgical resection and intraoperative electron radiotherapy for patients with para aortic recurrences of gastrointestinal and gynecologic malignancies |
| topic | Intraoperative radiotherapy Para-aortic recurrence Colorectal metastases |
| url | https://doi.org/10.1186/s13014-023-02289-2 |
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