Abstract
Background
We retrospectively examined outcomes of salvage high-dose-rate interstitial brachytherapy (HDR-ISBT) for locally recurrent rectal cancer (LRRC).
Methods
Nine patients with LRRC were treated with salvage HDR-ISBT. Their median age was 63 years. The median maximum diameter of LRRC was 40 mm (range 20–80 mm). Adenocarcinomas were histologically confirmed in all cases. The prescribed dose was 30 Gy/5 fractions/3 days to 50 Gy/10 fractions/6 days in the combined external-beam radiotherapy group (four patients) and 54 Gy/9 fractions/5 days to 60 Gy/10 fractions/6 days in the monotherapeutic group (five patients). Median follow-up time was 90 months (range 6–221 months).
Results
Local control at final follow-up was achieved in five of nine patients. Of these five patients, one experienced a locally re-recurrent tumor in the vaginal wall 33 months after treatment and received re-HDR-ISBT as re-salvage treatment. The 8-year overall survival, local control, and progression-free survival rates were 56, 44, and 33 %, respectively. Based on the Common Terminology Criteria for Adverse Events ver. 4.03, the following Grade 3 adverse events were observed in three patients (≥3 months): Grade 3 skin ulceration in one patient who showed tumor invasion of the skin and whose V100 was 400 cc; Grade 3 vaginal perforation in one patient whose tumor had invaded the vaginal wall; and Grade 3 vagina-to-bladder fistula in one patient whose tumor received re-irradiation. Late adverse events above Grade 3 were not observed.
Conclusions
Long-term follow-up results revealed that salvage HDR-ISBT is a promising treatment for LRRC with tolerable toxicity.
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References
Bouchard P, Efron J (2010) Management of recurrent rectal cancer. Ann Surg Oncol 17:1343–1356
Esnaola NF, Cantor SB, Johnson ML et al (2002) Pain and quality of life after treatment in patients with locally recurrent rectal cancer. J Clin Oncol 20:4361–4367
van den Brink M, Stiggelbout AM, van den Hout WB et al (2004) Clinical nature and prognosis of locally recurrent rectal cancer after total mesorectal excision with or without preoperative radiotherapy. J Clin Oncol 22:3958–3964
Lee JH, Kim DY, Kim SY et al (2011) Clinical outcomes of chemoradiotherapy for locally recurrent rectal cancer. Radiat Oncol 6:51
Sun DS, Zhang JD, Li L et al (2012) Accelerated hyperfractionation field-involved re-irradiation combined with concurrent capecitabine chemotherapy for locally recurrent and irresectable rectal cancer. Br J Radiol 85:259–264
Kusters M, Dresen RC, Martijn H et al (2009) Radicality of resection and survival after multimodality treatment is influenced by subsite of locally recurrent rectal cancer. Int J Radiat Oncol Biol Phys 75:1444–1449
Yamamoto M (2006) The experience of concomitant chemoradiation for locally recurrent rectal cancer (in Japanese). J Jpn Soc Ther Radiol Oncol 18:25–28
Wong CS, Cummings BJ, Brierley JD et al (1998) Treatment of locally recurrent rectal carcinoma—results and prognostic factors. Int J Radiat Oncol Biol Phys 40:427–435
Tsujii H, Kamada T, Baba M et al (2008) Clinical advantages of carbon-ion radiotherapy. New J Phys. doi:10.1088/1367-2630/10/7/075009
Sakurai H, Mitsuhashi N, Harashima K et al (2004) CT-fluoroscopy guided interstitial brachytherapy with image-based treatment planning for unresectable locally recurrent rectal carcinoma. Brachytherapy 3:222–230
Adam IJ, Mohamdee MO, Martin IG et al (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344:707–711
Uemura M, Ikeda M, Yamamoto H et al (2011) Clinicopathological assessment of locally recurrent rectal cancer and relation to local re-recurrence. Ann Surg Oncol 18:1015–1022
Yoshioka Y, Nose T, Yoshida K et al (2000) High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: treatment description and preliminary results of phase I/II clinical trial. Int J Radiat Oncol Biol Phys 48:675–681
Isohashi F, Yoshioka Y, Kiozumi M et al (2009) High-dose-rate interstitial brachytherapy for previous untreated cervical carcinoma. Brachytherapy 8:234–239
Hahnloser D, Nelson H, Gunderson LL et al (2003) Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 237:502–508
Acknowledgments
This work was supported in part by the Japan Society for Promotion Science (JSPS) Core-to-Core Program (Number 23003).
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The authors declare that they have no conflict of interest.
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Morimoto, M., Isohashi, F., Yoshioka, Y. et al. Salvage high-dose-rate interstitial brachytherapy for locally recurrent rectal cancer: long-term follow-up results. Int J Clin Oncol 19, 312–318 (2014). https://doi.org/10.1007/s10147-013-0567-0
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DOI: https://doi.org/10.1007/s10147-013-0567-0