“There has been a change in our thinking about patients who come in with otherwise unresectable disease,” Dr. Heidi Nelson told Reuters Health. “Over the past 10-15 years we have begun to employ multimodality therapy for patients who historically would not even have been referred to surgeons.”
Dr. Nelson and colleagues from the Mayo Clinic, Rochester, Minnesota and colleagues investigated the effects of multimodality therapy on survival, relapse, and the rate and intensity of complications in 146 patients with locally unresectable colorectal cancer.
After a median 3.7 years’ follow-up, central failure within the IORT boost field occurred in only 3 patients (2%), local failure in 19 patients (13%), regional failure in 6 (4%), and distant failure in 68 (47%), the authors report.
Eighty-six percent of patients were free from local recurrence at 5 years, the report indicates, and the estimated 5-year rate of freedom from distant metastasis was 51%.
At 5 years, disease-free survival was 43% and overall survival was 52%, the investigators say.
There was no perioperative mortality, and the perioperative morbidity rate was 8% (15 complications in 12 patients). Long-term morbidity reached 53% (119 late complications in 77 patients).
Age was the only significant predictor for disease-free survival, the researchers note, whereas age, adjuvant therapy, margin status, and pathologic N stage contributed to overall survival.
“Not surprisingly, when you use all the tools in your kit, you can heal some of these patients,” Dr. Nelson said. “Before you close the door, be sure someone familiar with this approach evaluates the patient.”
“We will continue to look for ways to reduce systemic failures,” Dr. Nelson added. “It’s important to treat optimistically and aggressively; intensive follow-up makes a difference even in these patients.”
Ann Surg 2008;248:592-598.