A study of radiotherapy modalities combined with continuous 5-FU infusion for locally advanced gastrointestinal malignancies

Aim. We describe the feasibility of combining infusional 5-fluorouracil (5-FU) with intraoperative radiation therapy (IORT). Methods. Patients with surgically resectable locally advanced gastrointestinal cancers were treated concurrently during surgery with IORT and a 72 h infusion of 5-FU. Patients...

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Bibliographic Details
Published in:	European journal of surgical oncology Vol. 30; no. 6; pp. 650 - 657
Main Authors:	Shibata, S.I, Pezner, R, Chu, D, Doroshow, J.H, Chow, W.A, Leong, L.A, Margolin, K.A, McNamara, M.V, Morgan, R.J, Raschko, J.W, Somlo, G, Tetef, M.L, Yen, Y, Synold, T.W, Wagman, L, Vora, N, Carroll, M, Lin, S, Longmate, J
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-08-2004
Subjects:	Adenocarcinoma - therapy Adult Aged Antineoplastic Agents - administration & dosage Colorectal cancer Combined Modality Therapy Digestive System Surgical Procedures - methods Feasibility Studies Female Fluorouracil - administration & dosage Gastrointestinal Neoplasms - therapy Humans Infusions, Intravenous Intraoperative Period Intraoperative radiation therapy Male Middle Aged Pancreatic cancer Pilot Projects Radiation sensitization Radiotherapy - methods Radiotherapy, High-Energy Treatment Outcome Intraoperative radiation therapy Radiation sensitization Pancreatic cancer Colorectal cancer
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Summary:	Aim. We describe the feasibility of combining infusional 5-fluorouracil (5-FU) with intraoperative radiation therapy (IORT). Methods. Patients with surgically resectable locally advanced gastrointestinal cancers were treated concurrently during surgery with IORT and a 72 h infusion of 5-FU. Patients without previous external beam radiation therapy (EBRT) were subsequently treated with EBRT (40–50Gy) concurrent with a 21-day continuous infusion of 5-FU. Pancreatic, gastric, duodenal, ampullary, recurrent colorectal, and recurrent anal cancer were included. Results. During IORT/5-FU, no chemotherapy-related grade III or IV hematologic or gastrointestinal toxicity was noted. Post-surgical recovery or wound healing was not affected. One of nine patients who received post-operative radiation required a treatment break. During follow-up, there were more complications in patients with pelvic tumours, especially those with previous radiation. Nine patients have had local and/or local regional recurrences, two of these in the IORT field. Conclusions. Treatment with a combination of IORT and 5-FU followed by EBRT and 5-FU is feasible. However, long-term complications may be increased in previously irradiated recurrent pelvic tumours.
ISSN:	0748-7983 1532-2157
DOI:	10.1016/j.ejso.2003.11.012