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Invited Critique
January 1999

Invited Critique: Resection With External Beam and Intraoperative Radiotherapy for Recurrent Colon Cancer

Arch Surg. 1999;134(1):67. doi:10.1001/archsurg.134.1.67

The role of adjuvant therapy for recurrent colorectal cancer is still evolving. Radical surgical resection alone or combined with external radiotherapy and often with chemotherapy have been commonly used in treating isolated locoregional recurrence of colon cancer. In the past 2 decades, a major advance in this field has been the addition of intraoperative radiotherapy (IORT) to external beam radiotherapy (EBRT).

Using this combination, Pezner and colleagues successfully treated a few patients with bulky recurrent colon tumors and achieved long-term local control and survival. Although small in number, this study has further illustrated important points. Intraoperative radiotherapy has the advantage of delivering a high-energy electron beam in a single dose to a clearly defined residual tumor bed without exposure and damage to adjacent organs and tissues. However, IORT and EBRT cannot eliminate local failures if complete tumor excision is not achieved, as observed in this study and others.1 Curative resections are often not possible in locally recurrent colon lesions because most recurrent tumors manifest with fixity to adjacent structures.