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Long-Term Survival After High-Dose-Rate Brachytherapy for Locally Advanced or Recurrent Colorectal Adenocarcinoma

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We evaluated outcomes of intraoperative radiotherapy delivered with focal high-dose-rate (HDR) brachytherapy [intraoperative radiotherapy (IORT)] in the management of locally recurrent (LR) and locally advanced (LA) primary T4 colorectal carcinoma (CRC). LR CRC or LA primary disease is a clinical challenge due to the difficulty in obtaining negative margins after radical surgery and the high risk of subsequent recurrence. Few data exist on long-term outcomes of patients treated with surgery and HDR-IORT for LR or LA primary CRC.

Methods

Three hundred CRC patients underwent HDR-IORT to the pelvis with gross surgical resection during November 1992–December 2007. Median follow-up for surviving patients was 53 (range 5–216) months. Eighty-eight patients (29 %) were treated for LA primary and 212 (71 %) LR disease. HDR-IORT was delivered using an iridium-192 remote afterloader and a Harrison–Anderson–Mick applicator. Median IORT dose was 1,500 (range 1,000–2,000) cGy.

Results

Five-year overall survival probability was 49 %. Positive margin status was associated with inferior overall survival and disease-free survival. Competing-risks analysis for time to local failure and distant metastases identified a 5-year cumulative incidence of local failure and distant metastases of 33 and 47 %, respectively. Five-year cumulative incidence of local failure was 22 % for the LA group and 38 % in the LR group. Five-year probability of disease-free survival was 48 and 31 % for LA and LR patients, respectively, and 5-year probability of overall survival was 56 and 45 % for LA and LR patients, respectively.

Conclusions

HDR-IORT combined with resection results in encouraging local control rates with acceptable toxicity for patients with locally aggressive CRC.

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References

  1. Suzuki K, Gunderson LL, Devine RM, Weaver AL, Dozois RR, Ilstrup DM, et al. Intraoperative irradiation after palliative surgery for locally recurrent rectal cancer. Cancer. 1995;75:939–52.

    Article  CAS  PubMed  Google Scholar 

  2. Lindel K, Willett CG, Shellito PC, Ott MJ, Clark J, Grossbard M, et al. Intraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer. Radiother Oncol. 2001;58:83–7.

    Article  CAS  PubMed  Google Scholar 

  3. Pelton J, Lanciano R, Hoffman J, Hanks G, Eisenberg B. The influence of surgical margins on advanced cancer treated with intraoperative radiation therapy (IORT) and surgical resection. J Surg Oncol. 1993;53:30–5.

    Article  CAS  PubMed  Google Scholar 

  4. Dresen RC, Gosens MJ, Martijn H, Nieuwenhuijzen GA, Creemers GJ, Daniels-Gooszen AW, et al. Radical resection after IORT-containing multimodality treatment is the most important determinant for outcome in patients treated for locally recurrent rectal cancer. Ann Surg Oncol. 2008;15:1937–47.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Eble MJ, Lehnert T, Treiber M, Latz D, Herfarth C, Wannenmacher M. Moderate dose intraoperative and external beam radiotherapy for locally recurrent rectal carcinoma. Radiother Oncol. 1998;49:169–74.

    Article  CAS  PubMed  Google Scholar 

  6. Mathis KL, Nelson H, Pemberton JH, Haddock MG, Gunderson LL. Unresectable colorectal cancer can be cured with multimodality therapy. Ann Surg. 2008;248:592–8.

    PubMed  Google Scholar 

  7. Wiig JN, Tveit KM, Poulsen JP, Olsen DR, Giercksky KE. Preoperative irradiation and surgery for recurrent rectal cancer. Will intraoperative radiotherapy (IORT) be of additional benefit? A prospective study. Radiother Oncol. 2002;62:207–13.

    Article  PubMed  Google Scholar 

  8. Gunderson LL, Nelson H, Martenson JA, Cha S, Haddock M, Devine R, et al. Locally advanced primary colorectal cancer: intraoperative electron and external beam irradiation +/− 5-FU. Int J Radiat Oncol Biol Phys. 1997;37:601–14.

    Article  CAS  PubMed  Google Scholar 

  9. Lanciano RM, Calkins AR, Wolkov HB, Buzydlowski J, Noyes RD, Sause W, et al. A phase I/II study of intraoperative radiotherapy in advanced unresectable or recurrent carcinoma of the rectum: a Radiation Therapy Oncology Group (RTOG) study. J Surg Oncol. 1993;53:20–9.

    Article  CAS  PubMed  Google Scholar 

  10. Bussieres E, Gilly FN, Rouanet P, Mahe MA, Roussel A, Delannes M, et al. Recurrences of rectal cancers: results of a multimodal approach with intraoperative radiation therapy. French Group of IORT. Intraoperative radiation therapy. Int J Radiat Oncol Biol Phys. 1996;34:49–56.

    Article  CAS  PubMed  Google Scholar 

  11. Kim HK, Jessup JM, Beard CJ, Bornstein B, Cady B, Stone MD, et al. Locally advanced rectal carcinoma: pelvic control and morbidity following preoperative radiation therapy, resection, and intraoperative radiation therapy. Int J Radiat Oncol Biol Phys. 1997;38:777–83.

    Article  CAS  PubMed  Google Scholar 

  12. Alektiar KM, Zelefsky MJ, Paty PB, Guillem J, Saltz LB, Cohen AM, et al. High-dose-rate intraoperative brachytherapy for recurrent colorectal cancer. Int J Radiat Oncol Biol Phys. 2000;48:219–26.

    Article  CAS  PubMed  Google Scholar 

  13. Harrison LB, Minsky BD, Enker WE, Mychalczak B, Guillem J, Paty PB, et al. High dose rate intraoperative radiation therapy (HDR-IORT) as part of the management strategy for locally advanced primary and recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 1998;42:325–30.

    Article  CAS  PubMed  Google Scholar 

  14. Wanebo HJ, Gaker DL, Whitehill R, Morgan RF, Constable WC. Pelvic recurrence of rectal cancer. Options for curative resection. Ann Surg. 1987;205:482–95.

    Article  CAS  Google Scholar 

  15. Wanebo HJ, Marcove RC. Abdominal sacral resection of locally recurrent rectal cancer. Ann Surg. 1981;194:458–71.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Cummings BJ, Rider WD, Harwood AR, Keane TJ, Thomas GM. Radical external beam radiation therapy for adenocarcinoma of the rectum. Dis Colon Rectum. 1983;26:30–6.

    Article  CAS  PubMed  Google Scholar 

  17. Sadahiro S, Suzuki T, Ishikawa K, Fukasawa M, Saguchi T, Yasuda S, et al. Preoperative radio/chemo-radiotherapy in combination with intraoperative radiotherapy for T3–4Nx rectal cancer. Eur J Surg Oncol. 2004;30:750–8.

    Article  CAS  PubMed  Google Scholar 

  18. Rhomberg W, Eiter H, Hergan K, Schneider B. Inoperable recurrent rectal cancer: results of a prospective trial with radiation therapy and razoxane. Int J Radiat Oncol Biol Phys. 1994;30:419–25.

    Article  CAS  PubMed  Google Scholar 

  19. Dosoretz DE, Gunderson LL, Hedberg S, Hoskins B, Blitzer PH, Shipley W, et al. Preoperative irradiation for unresectable rectal and rectosigmoid carcinomas. Cancer. 1983;52:814–8.

    Article  CAS  PubMed  Google Scholar 

  20. Mendenhall WM, Million RR, Bland KI, Pfaff WW, Copeland EM 3rd. Initially unresectable rectal adenocarcinoma treated with preoperative irradiation and surgery. Ann Surg. 1987;205:41–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Schild SE, Wong W. The role of retrograde urethrography in the planning of prostate cancer radiotherapy. Med Dosim. 1997;22:83–6.

    Article  CAS  PubMed  Google Scholar 

  22. Wallace HJ, 3rd, Willett CG, Shellito PC, Coen JJ, Hoover HC Jr. Intraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer. J Surg Oncol. 1995;60:122–7.

    Article  PubMed  Google Scholar 

  23. Nuyttens JJ, Kolkman-Deurloo IK, Vermaas M, Ferenschild FT, Graveland WJ, De Wilt JH, et al. High-dose-rate intraoperative radiotherapy for close or positive margins in patients with locally advanced or recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 2004;58:106–12.

    Article  PubMed  Google Scholar 

  24. Nag S, Martinez-Monge R, Martin EW. Intraoperative electron beam radiotherapy in recurrent colorectal carcinoma. J Surg Oncol. 1999;72:66–71.

    Article  CAS  PubMed  Google Scholar 

  25. Haddock MG, Miller RC, Nelson H, Pemberton JH, Dozois EJ, Alberts SR, et al. Combined modality therapy including intraoperative electron irradiation for locally recurrent colorectal cancer. Int J Radiat Oncol Biol Phys. 2011;79:143–50.

    Article  PubMed  Google Scholar 

  26. Calvo FA, Gomez-Espi M, Diaz-Gonzalez JA, Alvarado A, Cantalapiedra R, Marcos P, et al. Intraoperative presacral electron boost following preoperative chemoradiation in T3–4Nx rectal cancer: initial local effects and clinical outcome analysis. Radiother Oncol. 2002;62:201–6.

    Article  PubMed  Google Scholar 

  27. Nakfoor BM, Willett CG, Shellito PC, Kaufman DS, Daly WJ. The impact of 5-fluorouracil and intraoperative electron beam radiation therapy on the outcome of patients with locally advanced primary rectal and rectosigmoid cancer. Ann Surg. 1998;228:194–200.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Tepper JE, Gunderson LL, Orlow E, Cohen AM, Hedberg SE, Shipley WU, et al. Complications of intraoperative radiation therapy. Int J Radiat Oncol Biol Phys. 1984;10:1831–9.

    Article  CAS  PubMed  Google Scholar 

  29. Idrees K, Minsky B, Alektiar K, Guillem J, Weiser M, Temple L, et al. Surgical resection and high dose rate intraoperative radiation therapy for locally recurrent rectal cancer. Acta Chir Iugosl. 2004;51:11–8.

    Article  CAS  PubMed  Google Scholar 

  30. Dubois JB, Bussieres E, Richaud P, Rouanet P, Becouarn Y, Mathoulin-Pelissier S, et al. Intra-operative radiotherapy of rectal cancer: results of the French multi-institutional randomized study. Radiother Oncol. 2011;98:298–303.

    Article  PubMed  Google Scholar 

  31. Gunderson LL, Nelson H, Martenson JA, Cha S, Haddock M, Devine R, et al. Intraoperative electron and external beam irradiation with or without 5-fluorouracil and maximum surgical resection for previously unirradiated, locally recurrent colorectal cancer. Dis Colon Rectum. 1996;39:1379–95.

    Article  CAS  PubMed  Google Scholar 

  32. Morikawa LK, Zelefsky MJ, Cohen GN, Zaider M, Chiu J, Mathur N, et al. Intraoperative high-dose-rate brachytherapy using dose painting technique: evaluation of safety and preliminary clinical outcomes. Brachytherapy. 2013;12:1–7.

    Article  PubMed  Google Scholar 

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Stephanie Terezakis MD

  2. Department of Radiation Oncology, Clínicas Oncológicas Integradas (COI), Rio de Janeiro, Brazil

    Lisa Morikawa MD

  3. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Abraham Wu MD, Michael J. Zelefsky MD & Karyn A. Goodman MD

  4. Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Zhigang Zhang PhD & Weiji Shi MS

  5. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Martin R. Weiser MD, Philip B. Paty MD, Jose Guillem MD, Larissa Temple MD & Garrett M. Nash MD

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  1. Stephanie Terezakis MD
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  2. Lisa Morikawa MD
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  3. Abraham Wu MD
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Correspondence to Karyn A. Goodman MD.

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Terezakis, S., Morikawa, L., Wu, A. et al. Long-Term Survival After High-Dose-Rate Brachytherapy for Locally Advanced or Recurrent Colorectal Adenocarcinoma. Ann Surg Oncol 22, 2168–2178 (2015). https://doi.org/10.1245/s10434-014-4271-8

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  • DOI: https://doi.org/10.1245/s10434-014-4271-8

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