Sacropelvic resection and intraoperative radiation therapy: feasibility, technical description and early clinical results

Abstract

Sarcomas and locally recurrent colorectal carcinomas are disease entities in which sacral resection is an effective alternative for meaningful palliation with a limited cure expectation.To provide local control, pain palliation and a marginal expectation of definitive cure, a multimodality approach including external beam radiation therapy, surgical resection, and intraoperative radiation therapy (IORT), has been developed for patients with locally recurrent rectal cancers and primary sarcomas of the sacro-pelvic región.Seven consecutive patients (5 females; 2 males; ages, 40–75) underwent surgical exploration, sacrectomy, and IORT, between 1997 and 2000. IORT doses ranged from 10 to 12.5 Gy. External beam irradiation (EBRT) was used in six patients not previously irradiated (85%). Only 1 patient (14.2%) had received postoperative chemotherapy.Level of sacral resection: S2–S3 in 3 patients and S3–S4 in 2 patients. One patient with osteosarcoma underwent a posterior approach only, requiring removal of the posterior sacral table exclusively. An exclusively anterior approach was used in another patient with recurrent rectal cancer involving uterus, vagina and presacral fascia, requiring selective removal of the anterior sacral table. Margins: clear in 5 and microscopically involved in 2 patients. Postoperative mortality rate: 1 patient (14.2%). Three patients (42%) suffered major postoperative complications. Follow-up was available on six patients: time from surgery ranging from 1 to 36 (median 12.5) months. At the time of analysis, 5 out of 6 patients were alive without recurrent symptoms.Intensified local radiosurgical treatment with sacropelvic resection in conjunction with IORT provides palliation and offers potential for cure in patients with locally recurrent rectal cancer and sacropelvic sarcomas.