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Interstitial permanent implantation of 125I seeds as salvage therapy for re-recurrent rectal carcinoma

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

To assess the feasibility, efficacy, and morbidity of 125I seeds interstitial permanent implant as salvage therapy for re-recurrent rectal cancer.

Methods and materials

From September 2003 to October 2007, 125I seeds implant procedures were performed under CT or ultrasound guidance for thirteen patients with locally re-recurrent rectal carcinoma. The minimal peripheral doses (MPD) of 125I seeds implanted ranged from 120 to 160 Gy, with a median MPD of 140 Gy to total decay. Three patients also received two to four cycles of chemotherapy after seed implantation.

Results

After a median follow-up of 10 months (range 3–45), the pain-free interval was 0–14 months with a median of 7 months (95% CI: 3–11 months). The response rate of pain relief was 46.2% (6/13). Local control was 3–14 months with a median of 7 months (95% CI: 3.5–10.5 months). The 1- and 2-year local control rates were 14.4% and 0%, respectively. Three (23.1%) patients died of local recurrence; seven (53.8%) patients died of local recurrence and metastases; one (7.7%) patient died of metastases. Two (15.4%) patients survived to follow-up. At the time of analysis, the median survival was 10 months (95% CI: 3.9–16.1 months). The 1- and 2-year actuarial overall survival rates were 46.2% and 11.5%, respectively. Two (15.4%) patients experienced a grade 4 toxic event. Seed migration to the pelvic wall was observed in one (7.7%) patient. There was no associated neuropathy.

Conclusion

125I seed implantation is feasible, effective, and safe as a salvage or palliative treatment for patients with re-recurrent rectal cancer.

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Abbreviations

125I:

iodine-125

LDR:

low-dose rate

HDR:

high-dose rate

SLD:

sublethal damage

MPD:

minimal peripheral dose

TPS:

treatment planning system

EBRT:

external beam radiotherapy

GTV:

gross tumor volume

PTV:

planning target volume

SRT:

stereotactic radiotherapy

CR:

complete response

PR:

partial response

SD:

stable disease

PD:

progressive disease

TTP:

time to progression

OS:

overall survival

References

  1. Krook JE, Moertel CG, Gunderson LL et al (1991) Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 324:709–715

    Article  PubMed  CAS  Google Scholar 

  2. Benotti P, Steele G Jr (1992) Patterns of recurrent colorectal cancer and recovery surgery. Cancer 70(suppl 5):1409–1413

    Article  PubMed  CAS  Google Scholar 

  3. Kaplan EL, Meier P (1958) Nonparametric estimation for incomplete observations. J Am Stat Assoc 4:57–81

    Google Scholar 

  4. 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

    Article  PubMed  CAS  Google Scholar 

  5. Temple WJ, Ketcham AS (1992) Sacral resection for control of pelvic tumors. Am J Surg 163:370–374

    Article  PubMed  CAS  Google Scholar 

  6. Cunningham JD, Euker W, Cohen A (1997) Salvage therapy for pelvic recurrence following curative rectal cancer resection. Dis Colon Rectum 40:393–400

    Article  PubMed  CAS  Google Scholar 

  7. Farouk R, Nelson H, Gunderson LL et al (1997) Aggressive multimodality treatment for locally advanced irresectable rectal cancer. Br J Surg 84:741–749

    Article  PubMed  CAS  Google Scholar 

  8. Melton GB (2006) Diseases of the colon and rectum. Dis Colon Rectum 49:1099–10107

    Article  PubMed  Google Scholar 

  9. Wanebo HJ, Koness RJ, Vezeridis MP et al (1994) Pelvic resection of recurrent rectal cancer. Ann Surg 220:586–595

    Article  PubMed  CAS  Google Scholar 

  10. Kabbinavar FF, Hambleton J, Mass RD et al (2005) Combined analysis of efficacy: the addition of bevacizumab to fluorouracil/leucovorin improves survival for patients with metastatic colorectal cancer. J Clin Oncol 23:3706–3712

    Article  PubMed  CAS  Google Scholar 

  11. Abuchaibe O, Calvo FA, Azinovic I et al (1993) Intraoperative radiotherapy in locally advanced recurrent colorectal cancer. Int J Radiat Oncol Biol Phys 26:859–867

    Article  PubMed  CAS  Google Scholar 

  12. Nag S, Martinez-Monge R, Gupta N (1997) Intraoperative radiation therapy using electron beam and high-dose rate brachytherapy. Cancer J 10:94–101

    Google Scholar 

  13. Haddock MG, Gunderson LL, Nelson H et al (2001) Intraoperative irradiation for locally recurrent colorectal cancer in previously irradiated patients. Int J Radiat Oncol Biol Phys 49:1267–1274

    Article  PubMed  CAS  Google Scholar 

  14. Sindelar WF, Kinsella TJ, Chen PW et al (1993) Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized clinical trial. Arch Surg 128:402–410

    PubMed  CAS  Google Scholar 

  15. Magrini S, Nelson H, Gunderson LL et al (1996) Sacropelvic resection and intraoperative electron irradiation in the management of recurrent anorectal cancer. Dis Colon Rectum 39:1–9

    Article  PubMed  CAS  Google Scholar 

  16. Li Z (2000) Experimental measurements of dosimetric parameters on the transverse axis of a new 125I source. Med Phys 27:1275–1280

    Article  PubMed  CAS  Google Scholar 

  17. Cox JD, Stetz J, Pajak TF et al (1995) The toxicity criteria of the radiation therapy oncology for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346

    Article  PubMed  CAS  Google Scholar 

  18. Miller AB, Hoogstraten B, Staquet M et al (1981) Reporting results of cancer treatment. Cancer 47:207–214

    Article  PubMed  CAS  Google Scholar 

  19. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the international association for the study of pain subcommittee on taxonomy. Pain Suppl 3:S1–S226 (1986)

    Google Scholar 

  20. Zacherl J, Schiessel R, Windhager R et al (1999) Abdominosacral resection of recurrent rectal cancer in the sacrum. Dis Colon Rectum 42:1035–1040

    Article  PubMed  CAS  Google Scholar 

  21. Mannaerts GH, Rutten HJ, Martijn H et al (2001) Abdominosacral resection for primary irresectable and locally recurrent rectal cancer. Dis Colon Rectum 44:806–814

    Article  PubMed  CAS  Google Scholar 

  22. Yamada K, Ishizawa T, Niwa K et al (2002) Pelvic exenteration and sacral resection for locally advanced primary and recurrent rectal cancer. Dis Colon Rectum 45:1078–1084

    Article  PubMed  Google Scholar 

  23. Linggareddy V, Ahmad NR, Mohiuddin M (1997) Palliative reirradiation for recurrent rectal cancer. Int J Radiatin Oncology Biol Phys 38:785–790

    Article  Google Scholar 

  24. Abuchaibe O, Calvo FA, Azinovic I et al (1993) Intraoperative radiotherapy in locally advanced recurrent colorectal cancer. Int J Radiat Oncol Biol Phys 26:859–867

    Article  PubMed  CAS  Google Scholar 

  25. Bussieres E, Gilly FN, Rouanet P et al (1996) Recurrences of rectal cancer: results of a multimodal approach with introperative radiation therapy. Radiother Oncol 34:49–56

    CAS  Google Scholar 

  26. Wallace HJ, Willett CG, Shellito PC, Coen JJ et al (1995) Intraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer. J Surg Oncol 60:122–127

    Article  PubMed  Google Scholar 

  27. Morphy JT, Schmitz A (1956) Results of irradiation in cancer of the cervix. Radiology 67:378–385

    Google Scholar 

  28. Mazeron JJ, Noel G, Simon JM (2002) Head and neck brachytherapy. Semi Raidat Oncol 12:95–108

    Article  Google Scholar 

  29. Blasko JC, John TM, Peter S et al (2002) Brachytherapy for carcinoma of the prostate: techniques, patients selection and clinical outcome. Semi Radiat Oncol 12:81–94

    Article  Google Scholar 

  30. Fourqit A, Inker WE, Shank B et al (1985) The value of interstitial radiation in advanced recurrent colorectal cancer. Encuriether Hypertherm Oncol 1:113–117

    Google Scholar 

  31. Martinez RM, Nag S, Martin EW (1998) 125Iodine brachytherapy for colorectal adenocarcinoma recurrent in the pelvis and paraortics. Int J Radiatin Oncology Biol Phys 42:545–550

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Peking University Third Hospital, Beijing, China

    Jun Jie Wang, Jin Na Li, Wei Juan Jiang, Yu Liang Jiang & Su Qing Tian

  2. Department of Radiology, Peking University Third Hospital, Beijing, China

    Hui Shu Yuan

  3. Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100083, China

    Jun Jie Wang

Authors
  1. Jun Jie Wang
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  2. Hui Shu Yuan
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  3. Jin Na Li
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  4. Wei Juan Jiang
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  5. Yu Liang Jiang
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  6. Su Qing Tian
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Correspondence to Jun Jie Wang.

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Wang, J.J., Yuan, H.S., Li, J.N. et al. Interstitial permanent implantation of 125I seeds as salvage therapy for re-recurrent rectal carcinoma. Int J Colorectal Dis 24, 391–399 (2009). https://doi.org/10.1007/s00384-008-0628-4

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  • DOI: https://doi.org/10.1007/s00384-008-0628-4

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