Interventional procedure overview of intraoperative electron beam radiotherapy for locally advanced and locally recurrent colorectal cancer

Article

Number of patients and follow up

Direction of conclusions

Reason study was not included in main evidence summary

Ansell J, Perry WRG, Mathis KL et al. (2021) Re-resection of Microscopically Positive Margins Found on Intra-Operative Frozen Section Analysis Does Not Result in a Survival Benefit in Patients Undergoing Surgery and Intraoperative Radiation Therapy for Locally Recurrent Rectal Cancer. Diseases of the colon and rectum

Cohort study

n=267

FU=5 years

Re-resection of microscopically positive margins to obtain R0 status does not appear to provide a significant survival advantage or prevent local re-recurrence in patients undergoing surgery and intraoperative radiation therapy for locally recurrent rectal cancer.

Studies with more people or longer follow up included.

Azinovic I, Calvo FA, Santos M et al. (1997) Intense local therapy in primary rectal cancer: multi-institutional results with preoperative chemoradiation therapy plus IORT. Spanish Group of IORT. Frontiers of radiation therapy and oncology 31:196-9

Case series

n=76

FU=24 months

Intense local therapy including preoperative chemoradiation therapy, surgery and IORT is feasible, acceptably tolerated and able to induce a high local control rate (no recurrence detected in the IORT-boosted region).

Studies with more people or longer follow up included.

Brady JT, Crawshaw BP, Murrell B, et al. (2017) Influence of intraoperative radiation therapy on locally advanced and recurrent colorectal tumors: A 16-year experience. American journal of surgery 213(3):586-589

Case series

n=77

IORT resulted in low local failure rates and should be considered for patients with locally advanced or recurrent colorectal cancers.

Studies with more people or longer follow up included.

Bussieres E, Dubois JB, Demange L et al. (1997). IORT: a randomized trial in primary rectal cancer by the French group of IORT. Frontiers of radiation therapy and oncology 31:217-220

RCT

n=30

The performance of randomised trials is needed to demonstrate the possible benefit of IORT on the local control in cancer. Rectal cancer is one of

the locations which can benefit from a radiation booster, considering the

dramatic aspects of local failure.

Earlier publication of Dubois, 2011.

Bussieres E, Gilly FN, Rouanet P, et al. (1996) Recurrences of rectal cancers: results of a multimodal approach with intraoperative radiation therapy. French Group of IORT. Intraoperative Radiation Therapy. International journal of radiation oncology, biology, physics 34(1):49-56

Case series

n=73

FU=37 months

Intraoperative radiation therapy is a complementary treatment for recurrences of rectal cancer. It provides encouraging results, particularly in some selected situations, when patients have not previously been treated with external radiation therapy. Further studies of multimodal treatments are necessary.

Studies with more people or longer follow up included.

Calvo FA, Gomez-Espi M, Diaz-Gonzalez JA, et al. (2002) Intraoperative presacral electron boost following preoperative chemoradiation in T3-4Nx rectal cancer: initial local effects and clinical outcome analysis. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 62(2):201-206

Case series

n=100

FU=23 months

IOERT electron boost to the presacral region is feasible to integrate systematically in the intensive combined treatment of locally advanced rectal cancer, including neoadjuvant chemoradiation segment.

Studies with more people or longer follow up included.

Calvo FA, Sole CV, Alvarez de Sierra P, et al. (2013) Prognostic impact of external beam radiation therapy in patients treated with and without extended surgery and intraoperative electrons for locally recurrent rectal cancer: 16-year experience in a single institution. International journal of radiation oncology, biology, physics. 86(5):892-900

Case series

n=60

FU=36 months

Present results suggest that a significant group of patients with LRRC may benefit from EBRT treatment integrated with extended surgery and IOERT.

Studies with more people or longer follow up included.

Calvo FA, Sole CV, Serrano J et al. (2013) Post-chemoradiation laparoscopic resection and intraoperative electron-beam radiation boost in locally advanced rectal cancer: long-term outcomes.

Journal of cancer research and clinical oncology 139(11):1825-33

Case series

n=125

FU=59.5 months

Postchemoradiation laparoscopically assisted IOERT is feasible, with an acceptable risk of postoperative complications, shorter hospital stay, and similar long-term outcomes when compared to the open surgery approach.

Studies with more people or longer follow up included.

Cantero-Munoz P, Urien MA, Ruano-Ravina A (2011). Efficacy and safety of intraoperative radiotherapy in colorectal cancer: a systematic review. Cancer letters 306(2):121-133

Systematic review

n=15 studies

Adding IORT to conventional treatment reduces the incidence of local recurrences within the radiation area over 10%. IORT is a safe technique as it does not increase toxicity associated with conventional treatment.

More recent systematic reviews included.

Diaz-Gonzalez JA, Calvo FA, Cortes J, et al. (2006) Prognostic factors for disease-free survival in patients with T3-4 or N+ rectal cancer treated with preoperative chemoradiation therapy, surgery, and intraoperative irradiation. International journal of radiation oncology, biology, physics 64(4):1122-1128

Case series

n=115

Females with an intense pathologic response (pT(mic) residue) to preoperative chemoradiotherapy have an excellent 3-year disease-free survival.

Studies with more people and more relevant outcomes included.

Dresen RC, Gosens MJ, Martijn H, et al. (2008) Radical resection after IORT-containing multimodality treatment is the most important determinant for outcome in patients treated for locally recurrent rectal cancer. Annals of surgical oncology 15(7):1937-1947

Case series

n=147

FU=34 months

Radical resection is the most significant predictor of improved survival in patients with LRRC. Neoadjuvant radio (chemo-) therapy is the best option in order to realise a radical resection. Re-irradiation is feasible in patients who already received irradiation as part of the primary rectal cancer treatment.

Studies with more people or longer follow up included.

Dubois J-B, Bussieres E, Richaud P et al. (2011) Intra-operative radiotherapy of rectal cancer: results of the French multi-institutional randomized study.

Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology 98(3): 298-303

RCT

n=73

FU=61.2 months

Although this randomised study did not demonstrate any significant improvement in local control and disease-free survival in rectal cancer patients treated with preoperative radiation therapy receiving IORT or not, it confirmed the technical feasibility and the necessity for evaluating IORT for rectal carcinoma in further clinical studies.

Included in the Fahy, 2021 and Liu, 2021 systematic reviews.

Eble MJ, Lehnert T, Herfarth C, Wannenmacher M (1998). Intraoperative radiotherapy as adjuvant treatment for stage II/III rectal carcinoma. Recent results in cancer research Fortschritte der Krebsforschung Progres dans les recherches sur le cancer 146:152-160

Case series

n=63

Moderate-dose IORT and EBRT is safe, considering related late toxicities. It is an effective local treatment approach, resulting in an encouraging local control rate.

Studies with more people or longer follow up included.

Eble MJ, Lehnert T, Herfarth C, Wannenmacher M (1997). IORT as adjuvant treatment in primary rectal carcinomas: multi-modality treatment. Frontiers of radiation therapy and oncology 31:200-203

Case series

n=104

FU=30.6 months

IORT seems to be ideal

for this purpose. Compared with a historical control the risk of small-bowel

obstruction was markedly reduced in our series (7 versus 0%) while local control

is excellent.

Studies with more people or longer follow up included.

Elashwah A, Alsuhaibani A, Alzahrani A, et al. (2022) The Use of Intraoperative Radiation Therapy (IORT) in Multimodality Management of Cancer Patients: a Single Institution Experience. Journal of Gastrointestinal Cancer

Case series

n=188

The data presented discusses using of IORT treatment for different malignant tumours as a part of multimodality treatment. IORT seems safe and feasible; however, a longer follow-up period is needed for proper evaluation and to define the role of IORT in a tailored multimodality approach.

Studies with more people or longer follow up included.

Gunderson LL, Martin JK, Beart RW, et al. (1998) Intraoperative and external beam irradiation for locally advanced colorectal cancer. Annals of surgery. 207(1):52-60

Case series

n=51

The incidence of distant metastases is high in patients with recurrence, but subsequent peritoneal failures are infrequent. Acute and chronic tolerance have been acceptable, but peripheral nerve appears to be a dose-limiting structure. Randomised trials are needed to determine whether potential gains with IORT are real.

Studies with more people or longer follow up included.

Gunderson LL, Nelson H, Martenson JA, et al. (1997) Locally advanced primary colorectal cancer: intraoperative electron and external beam irradiation +/- 5-FU. International journal of radiation oncology, biology, physics. 37(3):601-614

Case series

n=61

FU=>18 months

Both OS and disease control appear to be improved with the addition of IOERT to standard treatment. More routine use of systemic therapy is indicated as a component of IOERT-containing treatment regimens because the incidence of distant metastases was 50% of patients at risk.

Studies with more people or longer follow up included.

Gunderson LL, Nelson H, Martenson JA, et al. (1996) Intraoperative electron and external beam irradiation with or without 5-fluorouracil and maximum surgical resection for previously unirradiated, locally recurrent colorectal cancer. Diseases of the colon and rectum 39(12):1379-1395

Case series

n=123

Even with locally recurrent lesions, the aggressive multimodality approaches including IOERT have resulted in improved local control and long-term survival rates of 20 percent versus an expected 5 percent with conventional techniques.

Studies with more people or longer follow up included.

Haddock MG, Gunderson LL, Nelson H, et al. (2001) Intraoperative irradiation for locally recurrent colorectal cancer in previously irradiated patients. International journal of radiation oncology, biology, physics 49(5):1267-1274

Case series

n=51

FU=21 months

Long-term local control can be obtained in a substantial proportion of patients with aggressive combined modality therapy, but long-term survival is poor due to the high rate of distant metastasis. Re-irradiation with EBRT in addition to IOERT appears to improve local control. Strategies to improve survival in these poor-risk patients may include the more routine use of conventional systemic chemotherapy or the addition of novel systemic therapies.

Studies with more people or longer follow up included.

Ishikura S, Ogino T, Ono M, et al. (1999) Preliminary results of pelvic autonomic nerve-preserving surgery combined with intraoperative and postoperative radiation therapy for patients with low rectal cancer. Japanese journal of clinical oncology. 29(9):429-433

Case series

n=50

FU=41 months

The preliminary results showed good local control rate for patients with stage I-II tumours. For patients with stage III tumours, the local control rate was unsatisfactory, but nerve sparing was not the cause of local recurrence. Further investigation of function-preserving surgery without decreasing curability is needed.

Studies with more people or longer follow up included.

Kienle P, Abend F, Dueck M et al. (2006) Influence of intraoperative and postoperative radiotherapy on functional outcome in patients undergoing standard and deep anterior resection for rectal cancer. Diseases of the colon and rectum 49(5):557-567

Cohort study

n=63 with IOERT

Patients with anterior resection for rectal cancer who undergo full-dose radiotherapy have significantly more impairment of anorectal function than patients without radiotherapy. Patients who were only exposed to intraoperative radiotherapy showed moderate impairment of continence function, suggesting that the influence of radiotherapy on anal function may be dose-dependent and application-dependent.

Studies with more people or longer follow up included.

Klink CD, Binnebosel M, Holy R et al. (2014). Influence of intraoperative radiotherapy (IORT) on perioperative outcome after surgical resection of rectal cancer. World journal of surgery. 38(4):992-996

Cohort study

n=52

Intraoperative radiotherapy appears to be a safe treatment option in patients with locally advanced or recurrent rectal cancer with acceptable complication rates. The effect on local recurrence rate has to be estimated in long-term follow up.

Included in the Liu, 2021 systematic review.

Krempien R, Roeder F, Oertel S, et al. (2006) Long-term results of intraoperative presacral electron boost radiotherapy (IOERT) in combination with total mesorectal excision (TME) and chemoradiation in patients with locally advanced rectal cancer. International journal of radiation oncology, biology, physics 66(4):1143-1151

Case series

n=210

FU=61 months

Multimodality treatment with TME and IOERT boost in combination with moderate dose pre- or postoperative chemoradiotherapy is feasible and results in excellent long-term local control rates in patients with intermediate to high-risk locally advanced rectal cancer.

Studies with more people or longer follow up included.

Kusters M, Holman FA, Martijn H, et al. (2009) Patterns of local recurrence in locally advanced rectal cancer after intra-operative radiotherapy containing multimodality treatment. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 92(2):221-225

Case series

n=299

Multimodality treatment is effective in the prevention of local recurrence in LARC. IORT application to the area most at risk is feasible and seems effective in the prevention of local recurrence. Dorsal tumour location results in unfavourable oncologic results.

Studies with more people or longer follow up included.

Llaguna OH, Calvo BF, Stitzenberg KB, et al. (2011) Utilization of interventional radiology in the postoperative management of patients after surgery for locally advanced and recurrent rectal cancer. The American surgeon 77(8):1086-1090

Case series

n=66

Surgery for locally advanced primary rectal cancer and locally recurrent rectal cancer is associated with significant morbidity but low mortality. Interventional radiologic procedures play a significant role in the postoperative management of these patients and may decrease the need for reoperation.

Studies with more people or longer follow up included.

Mannaerts GHH, Rutten HJT, Martijn H, et al. (2002). Effects on functional outcome after IORT-containing multimodality treatment for locally advanced primary and locally recurrent rectal cancer. International journal of radiation oncology, biology, physics 54(4):1082-1088

Case series

n=97

FU=14 months

As a result of multimodality treatment, the majority of these patients have to deal with long-term physical morbidity, the need for help with daily care, and considerable social impairment. These consequences must be weighed against the chance of cure if the patient is treated and the disability eventually caused by uncontrolled tumour progression if the patient is not treated. These potential drawbacks should be discussed with the patient preoperatively and taken into account when designing a treatment strategy.

Studies with more people or longer follow up included.

Masaki T, Matsuoka H, Kishiki T et al. (2020) Intraoperative radiotherapy for resectable advanced lower rectal cancer-final results of a randomized controlled trial (UMIN000021353).

Langenbeck's archives of surgery 405(3):247-54

RCT

n=38

FU=69 months

With the aid of IORT, complete pelvic autonomic nerve preservation can be done without increase of pelvic sidewall recurrence; however, IORT

may increase the incidence of distant metastases. Therefore, IORT cannot be recommended as a standard therapy to compensate

less radical resection for advanced lower rectal cancer.

Included in the Fahy, 2021 and Liu, 2021 systematic reviews.

Mathis KL, Nelson H, Pemberton JH (2008). Unresectable colorectal cancer can be cured with multimodality therapy. Annals of surgery 248(4):592-598

Case series

n=146

FU=3.7 years

Aggressive multimodality therapy for locally unresectable primary colorectal cancer results in excellent local disease control and a 5-year disease-free and OS rate of 43% and 52% respectively with no operative mortality and acceptable perioperative morbidities.

Studies with more people or longer follow up included.

Mirnezami R, Chang GJ, Das P, et al. (2013) Intraoperative radiotherapy in colorectal cancer: systematic review and meta-analysis of techniques, long-term outcomes, and complications. Surgical oncology. 22(1):22-35

Systematic review and meta-analysis

Despite methodological weaknesses in the studies evaluated, our results suggest that IORT may improve oncological outcomes in advanced and recurrent colorectal cancer.

More recent systematic reviews included.

Nakfoor BM, Willett CG, Shellito PC, et al. (1998). The impact of 5-fluorouracil and intraoperative electron beam radiation therapy on the outcome of patients with locally advanced primary rectal and rectosigmoid cancer. Annals of surgery 228(2):194-200

Case series

n=145

FU=53 months

Treatment strategies using 5-FU during irradiation and IOERT for patients with locally advanced rectal cancer are beneficial and well tolerated.

Studies with more people or longer follow up included.

Nordkamp S, Voogt ELK, van Zoggel DMGI, et al. (2022) Locally recurrent rectal cancer: oncological outcomes with different treatment strategies in two tertiary referral units. The British journal of surgery 109(7):623-631

Cohort study

n=377

FU=36 months

In radiotherapy-naive patients, neoadjuvant full-course chemoradiation confers the best oncological outcome. However, neoadjuvant therapy does not diminish the need for extended radical surgery to increase R0 resection rates.

Studies with more people or longer follow up included.

Noyes RD, Weiss SM, Krall JM et al. (1992) Surgical complications of intraoperative radiation therapy: the Radiation Therapy Oncology Group experience. Journal of surgical oncology 50(4):209-15

Cohort study

n=129

his large multi-institutional experience in patients with advanced malignancy demonstrates that patients receiving IORT do not have a higher surgical complication rate than those not receiving IORT. Long-term survival data await the implementation of Phase III trials in advanced intraabdominal malignancy.

Complications assessed in the Fahy, 2021 and Liu, 2021 systematic reviews.

Pacelli F, Sanchez AM, Covino M, et al. (2013) Improved outcomes for rectal cancer in the era of preoperative chemoradiation and tailored mesorectal excision: a series of 338 consecutive cases. The American surgeon 79(2):151-161

Case series

n=338

FU=59 months

The extent of mesorectal excision should be tailored depending on tumour location and the use of neoadjuvant chemotherapy, combined with IORT in advanced middle and low rectal cancer, leading to remarkable tumour downstaging with excellent prognosis in responding patients.

Studies with more people or longer follow up included.

Potemin S, Kubler J, Uvarov I, et al. (2020) Intraoperative radiotherapy as an immediate adjuvant treatment of rectal cancer due to limited access to external-beam radiotherapy. Radiation oncology (London, England) 15(1):11.

Cohort study

n=172

FU=23 months

IORT is a valuable option for patients with locally advanced rectal cancer in the absence of access to EBRT.

Studies with more people or longer follow up included.

Roeder F, Goetz JM, Habl G, et al. (2012) Intraoperative Electron Radiation Therapy (IOERT) in the management of locally recurrent rectal cancer. BMC cancer 12:592

Case series

n=54

FU=51 months

Long-term OS and local control can be achieved in a substantial proportion of patients with recurrent rectal cancer using a multimodality IOERT-containing approach, especially in case of clear margins. Local control and OS remain limited in patients with incomplete resection. Preoperative re-irradiation and adjuvant chemotherapy may be considered to improve outcome.

Studies with more people or longer follow up included.

Roeder F, Treiber M, Oertel S et al. (2007) Patterns of failure and local control after intraoperative electron boost radiotherapy to the presacral space in combination with total mesorectal excision in patients with locally advanced rectal cancer. International journal of radiation oncology, biology, physics 67(5);1381-8

Case series

n=243

FU=59 months

Intraoperative electron beam radiotherapy as part of a multimodal treatment approach including TME is a highly effective regimen to prevent local failure. The presacral space remains the site of highest risk for local failure, but IOERT can decrease the percentage of relapses in this area.

Studies with more people or longer follow up included.

Rutten HJ, Mannaerts GH, Martijn H, Wiggers T. (2000) Intraoperative radiotherapy for locally recurrent rectal cancer in The Netherlands. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 26suppla:16-20

Case series

n=62

Total dose of irradiation and completeness of resection were significantly correlated to a better prognosis.

Studies with more people or longer follow up included.

Sadahiro S, Suzuki T, Ishikawa K, et al. (2004) Preoperative radio/chemo-radiotherapy in combination with intraoperative radiotherapy for T3-4Nx rectal cancer. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 30(7):750-8

Cohort study

n=99

FU=67 months

The combined preoperative radio/chemoradiotherapy and IORT for clinical T3-4Nx rectal cancer significantly reduces local recurrence and improves prognosis. Combination of preoperative radiotherapy and oral chemotherapy improves the feasibility of sphincter-preservation.

Included in the Fahy, 2021 and Liu, 2021 systematic reviews..

Sadahiro S, Suzuki T, Ishikawa K, et al. (2001) Intraoperative radiation therapy for curatively resected rectal cancer. Diseases of the colon and rectum 44(11):1689-1695

Case series

n=78

In patients with adenocarcinoma of the middle or lower third of the rectum, intraoperative radiotherapy to the entire dissected surface of the pelvis reduced local recurrence in Stage II and Stage III patients and improved survival in Stage II patients.

Likely overlap with Sadahiro, 2004.

Sofo L, Ratto C, Doglietto GB, et al. (1996) Intraoperative radiation therapy in integrated treatment of rectal cancers. Results of phase II study. Diseases of the colon and rectum 39(12):1396-1403

Case series

n=68

FU=28.3/ 25.9 months

Results of this study suggest that multimodal treatment (including IORT) in rectal cancer is safe, has no significant increase of mortality and morbidity, and also shows a trend for local improvement. A longer term follow up and larger numbers of patients could demonstrate the therapeutic efficacy of IORT in rectal cancer.

Studies with more people or longer follow up included.

Sole CV, Calvo FA, Serrano J et al. (2014) Post-chemoradiation intraoperative electron-beam radiation therapy boost in resected locally advanced rectal cancer: long-term results focused on topographic pattern of locoregional relapse. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology 112(1):52-8

Case series

n=335

FU=72.6 months

Overall results after multimodality treatment of LARC are promising. Classification of risk factors for LRRC has contributed to propose a prognostic index that could allow us to guide risk-adapted tailored treatment.

Studies with more people or longer follow up included.

Tepper JE, Wood WC, Cohen AM. (1989) Treatment of locally advanced rectal cancer with external beam radiation, surgical resection, and intraoperative radiation therapy. International journal of radiation oncology, biology, physics 16(6):1437-1444

Case series

n=60

The local control and survival results in the primary tumours appear favourable compared with other series in the literature and suggest benefit to the use of IORT. For patients treated for local recurrence, local control and long-term survival can be obtained, but the results are not as encouraging as for the primary tumours.

Studies with more people or longer follow up included.

Tveit KM, Wiig JN, Olsen DR, et al. (1997) Combined modality treatment including intraoperative radiotherapy in locally advanced and recurrent rectal cancer. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology 44(3):277-82

Case series

n=115

FU=up to 60 months

The combined modality treatment with preoperative external radiotherapy and extensive pelvic surgery with IORT is sufficiently promising to start a randomised trial on the clinical value of IORT as a boost treatment in the multidisciplinary approach to this disease.

Studies with more people or longer follow up included.

Valentini V, Coco C, Rizzo G, et al. (2009) Outcomes of clinical T4M0 extra-peritoneal rectal cancer treated with preoperative radiochemotherapy and surgery: a prospective evaluation of a single institutional experience. Surgery 145(5):486-494

Cohort study

n=100

FU=31 months

A multimodal approach enabled us to obtain a 5-year OS of about 60%. IORT increased local control. The role of adjuvant chemotherapy needs to be further investigated.

Included in the Fahy, 2021 and Liu, 2021 systematic reviews.

Valentini V, Rosetto ME, Fares C (1998) Radiotherapy and local control in rectal cancer. Rays 23(3):580-585

Case series

n=71

FU=6 years

The incidence of metastases was 35% in the patients with local recurrence and 16% in those with local control. The difference in survival was highly significant in patients with local control as compared with those with local recurrence: at 5 years 87% and 32% respectively. Patients with local control showed a lower incidence of metastasis and a better survival.

Studies with more people or longer follow up included.

Wiig JN, Poulsen JP, Tveit KM et al. (2000) Intra-operative irradiation (IORT) for primary advanced and recurrent rectal cancer. a need for randomised studies. European journal of cancer (Oxford, England : 1990) 36(7):868-874

Cohort study

n=80

FU=22 months

IORT did not seem to influence the local recurrence rate when R0 and R1 resections were analysed separately or in a multivariate analysis. The IORT and surgery/EBRT groups were not identical with regard to type of cancer and R-stage. Still the lack of an identifiable impact of IORT suggests that there is a need for randomised studies of the IORT effect.

Included in the Fahy, 2021 systematic review.

Wiig JN, Tveit KM, Poulsen JP, et al. (2002). Preoperative irradiation and surgery for recurrent rectal cancer. Will intraoperative radiotherapy (IORT) be of additional benefit? A prospective study. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology 62(2):207-213

Cohort study

n=59

Macroscopic removal of the recurrence improves survival. Whether R0- is better than R1-resections is not clear. The effect of IORT is not a major one. IORT need be evaluated in randomised controlled trials.

Included in the Liu, 2021 systematic review.

Zhang Q, Tey J, Yang Z, et al. (2015) Adjuvant chemoradiation plus intraoperative radiotherapy versus adjuvant chemoradiation alone in patients with locally advanced rectal cancer. American journal of clinical oncology 38(1):11-16

Cohort study

n=71

FU=72.3 months

For patients with locally advanced rectal cancer, higher radiation dose may contribute to the improvement of both LC and disease-free survival, without significantly increasing the incidence of acute and long-term complications compared with adjuvant chemoradiotherapy alone.

Included in the Fahy, 2021 systematic review.