Feasibility and Early Results of Interstitial Intensity-Modulated HDR/PDR Brachytherapy (IMBT) with/without Complementary External-Beam Radiotherapy and Extended Surgery in Recurrent Pelvic Colorectal Cancer

Abstract

The combination of extended surgery and postoperative interstitial IMBT is feasible and offers effective interdisciplinary treatment of recurrent colorectal cancer. In this small and inhomogeneous cohort of patients PDR seems to be more effective than HDR, particularly when application of complementary EBRT is not possible. None of the patients who required resection of distant metastasis survived > 2 years in this study.

Clinical outcome of interstitial pulsed dose rate brachytherapy in multimodality treatment of locally advanced primary or recurrent rectal and sigmoid cancer with high risk of incomplete microscopic resection

“…We believe that recurrent disease in itself is not a disqualification for multimodality treatment. This view is supported by the study of Tepel et al, who used a setup similar to ours and reported an overall five-year survival of 23% for recurrent colorectal cancer [10].…”

“…Several studies have shown that radical resection has a significant influence on local control [9][10][11]20,21]. However, like Nuyttens et al [17], we did not find a statistically significant impact when comparing patients with R0 and R1 resection.…”

“…This finding could be attributed to lack of power but could also be partly attributed to an effect of PDR-BT being able to compensate for an R1 resection because, in the first two years after surgery, the local control was similar between R0 and R1 resection (Figure 2(c)). Furthermore, the five-year local control rate of 32% after R1 resection is good compared to other studies [10,12,14,22,23]. This is further supported by the observation that the number of catheters significantly influenced the possibility of achieving local control.…”

“…The complications were divided into early (within 90 days after surgery) and late (more than 90 days after surgery) complications. Based on previous experience with IORT electrons and HDR-BT [10][11][12][13][14] we selected soft tissue necrosis, osteonecrosis, insufficiency fracture, neuropathy and neural pain as complications that could potentially be more directly related to PDR-BT. The survival and follow-up were recorded until 4 April 2014.…”

“…For patients with recurrent disease, the situation is often further complicated by a decreased radiation tolerance of the pelvis due to previous EBRT [8]. Intra-operative electron beam radiotherapy (IORT), high dose rate brachytherapy (HDR-BT) or pulsed dose rate brachytherapy (PDR-BT) have been used to give an additional RT boost directly to the tumor bed to increase the chance of obtaining local control in these patients [9][10][11][12][13][14].…”