TY - JOUR
T1 - Intraoperative brachytherapy alone for incomplete resected recurrent rectal cancer
AU - Minsky, Bruce D.
AU - Cohen, Alfred M.
AU - Fass, Daniel
AU - Enker, Warren E.
AU - Sigurdson, Elin
AU - Harrison, Louis
PY - 1991/6
Y1 - 1991/6
N2 - In order to determine the impact of intraoperative brachytherapy alone in patients with recurrent rectal cancer who, due to prior pelvic radiation therapy, were ineligible to receive further external beam pelvic radiation, we retrospectively reviewed the records of 36 patients with recurrent rectal cancer who had gross residual disease remaining in the pelvis following biopsy alone or subtotal resection. The median follow-up was 24 months (6-81 months). The median survival was 27 months and the 4 year actuarial survival was 25%. There was a suggestion of lower survival in patients who underwent biopsy alone compared with those who underwent a subtotal resection (21% vs. 34%). The local failure (LF) rate was 22 % as the only site of failure and 44% as a component of failure. There was a lower but non-significant LF rate in patients who underwent subtotal resection vs. biopsy alone (33% vs. 66%) and those with an 125I implant volume of < 40 cm3 vs. ≥ 40 cm3 (39% vs. 100%). Four patients (11%) developed treatment-related severe complications (without evidence of LF). Our data suggest that, although it is not clear that intraoperative brachytherapy impacts on the ultimate survival rate in this group of patients, it does offer reasonable local control with acceptable morbidity. Since local control, in and of itself is an important endpoint in the treatment of rectal cancer, we continue to recommend brachytherapy as part of an overall aggressive approach in patients who are unable to receive pelvic radiation therapy.
AB - In order to determine the impact of intraoperative brachytherapy alone in patients with recurrent rectal cancer who, due to prior pelvic radiation therapy, were ineligible to receive further external beam pelvic radiation, we retrospectively reviewed the records of 36 patients with recurrent rectal cancer who had gross residual disease remaining in the pelvis following biopsy alone or subtotal resection. The median follow-up was 24 months (6-81 months). The median survival was 27 months and the 4 year actuarial survival was 25%. There was a suggestion of lower survival in patients who underwent biopsy alone compared with those who underwent a subtotal resection (21% vs. 34%). The local failure (LF) rate was 22 % as the only site of failure and 44% as a component of failure. There was a lower but non-significant LF rate in patients who underwent subtotal resection vs. biopsy alone (33% vs. 66%) and those with an 125I implant volume of < 40 cm3 vs. ≥ 40 cm3 (39% vs. 100%). Four patients (11%) developed treatment-related severe complications (without evidence of LF). Our data suggest that, although it is not clear that intraoperative brachytherapy impacts on the ultimate survival rate in this group of patients, it does offer reasonable local control with acceptable morbidity. Since local control, in and of itself is an important endpoint in the treatment of rectal cancer, we continue to recommend brachytherapy as part of an overall aggressive approach in patients who are unable to receive pelvic radiation therapy.
KW - Brachytherapy
KW - Intraoperative radiation therapy
KW - Recurrent rectal cancer
KW - Unresectable rectal cancer
UR - http://www.scopus.com/inward/record.url?scp=0025865942&partnerID=8YFLogxK
U2 - 10.1016/0167-8140(91)90083-S
DO - 10.1016/0167-8140(91)90083-S
M3 - Article
C2 - 1714083
AN - SCOPUS:0025865942
SN - 0167-8140
VL - 21
SP - 115
EP - 120
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 2
ER -