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Session: ePoster: Colon and Colorectal Cancer 21 (Sat315)

EP121 - Outcomes of Intraoperative Radiation Therapy in Rectal Cancer – An Analysis of the U.S. National Cancer Database

Saturday, May 10, 2025
3:47 PM – 3:52 PM PT
Location: Monitor 3, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • MP

    Michal Perets, MD

    Clinical Fellow
    Cleveland Clinic Florida
    Weston, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Nir Horesh, MD

    Resident Physician
    Cleveland Clinic Florida
    Cleveland Clinic Florida
    Weston, FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Sameh H. Emile, MBBCh, MSc, MD, FACS

    Project Scientist
    Cleveland Clinic Florida
    Cleveland Clinic Florida
    Plantation , FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

  • SK

    Shayan Khalafi, MD

    Surgeon
    Cleveland Clinic Florida
    Weston, FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Zoe Garoufalia, MD (she/her/hers)

    Colorectal Surgery Fellow
    Cleveland Clinic Florida
    Cleveland Clinic Florida
    Weston, FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Steven D. Wexner, MD, PhD (Hon), MD, PhD (Hon), FACS, FRCS, FRCSI, MAMSE

    Emeritus Chair, Department of Colorectal Surgery
    Cleveland Clinic Florida
    Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
    Weston, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Michal Perets, MD: This individual has no financial relationships with ineligible companies.
Nir Horesh, MD: This individual has no financial relationships with ineligible companies.
Sameh H. Emile, MBBCh, MSc, MD, FACS: This individual has no relevant relationships with ineligible companies.
Shayan Khalafi, MD: This individual has no financial relationships with ineligible companies.
Zoe Garoufalia, MD: This individual has no financial relationships with ineligible companies.
Steven D. Wexner, MD, PhD (Hon), FACS, FRCS, FRCSI, MAMSE, MD, PhD (Hon): This individual has no relevant relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Local recurrence remains a significant challenge in the management of rectal adenocarcinoma, particularly in locally advanced disease. Currently, local control is achieved through the combination of preoperative chemoradiotherapy and surgical resection. Intraoperative radiation therapy (IORT) is an option in some settings, but its use in the treatment of rectal cancer is uncommon. In this study, we aimed to assess the short- and long-term outcomes of patients receiving IORT alone or with additional radiation therapy prior to or following surgery.

Methods/Interventions: A retrospective cohort analysis of patients with rectal cancer treated with IORT in the National Cancer Database (NCDB) from 2010-2021 was conducted. The results of the entire cohort were described and a comparison between patients treated with IORT alone or with additional pre/post-operative radiation was conducted. The primary outcome was 5-year overall survival (OS), secondary outcomes included 30-day readmissions, and 30-day and 90-day mortality.

Results/Outcomes: A total of 140 patients (66.4% male, median age 57 years) with clinical stages II (35%) and III (65%) rectal cancer were included. 24 patients (17.1%) underwent IORT alone and 116 (82.9%) received IORT in conjunction with preoperative and/or postoperative radiation therapy. The majority of patients (97.9%) presented with T3/T4 clinical stage and 65.7% had clinical nodal disease. Treatment was mainly received at academic or research centers (69.6%). Pathological examination indicated advanced T stage in 80.3% of patients and nodal disease in 35.8%. R0 resection was achieved in 79.3% of patients. The 30-and 90-day mortality rates were 0.8% and 1.6%, respectively. Unplanned readmissions were recorded in 10% of patients. When comparing patients receiving IORT alone versus patients receiving IORT with additional radiation therapy - the clinical N-stage (p=0.002) and clinical TNM stage (p=0.001) were significantly higher in the IORT combined with other treatment modality group. Although patients in the combined IORT group had longer overall survival (50.9 months, 95% CI 47.7-54.1) compared to patients treated with IORT alone (45.5 months, 95%CI 38.3-52.7), it did not amount to a statistical significance (p=0.18).

Conclusion/Discussion: Patients treated with IORT tended to have locally advanced tumors. Survival in patients treated with IORT alone was found to be comparable to patients treated with IORT with pre/post operative radiation. Further research is needed to evaluate the efficacy of this therapeutic approach