High-dose-rate intraoperative radiotherapy for close or positive margins in patients with locally advanced or recurrent rectal cancer

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

“…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.…”

“…Nuyttens et al reported a significant difference in local control between primary and recurrent disease in only 37 patients (p ¼ .042) using HDR-BT [12]. Selection bias and the limited number of patients involved in all three studies are likely explain this difference.…”

“…In general, the literature reporting the results of IORT and BT in PARC or LRCC is difficult to analyze as many of the studies applied these treatments only in cases of increased risk of incomplete resection, whereas other centers used IORT or BT routinely in the presacral space regardless of the tumor topography and the expected surgical result [10,12,14,25,26]. Furthermore, the definition of close or positive margins varied, and only a few studies included both primary and recurrent disease [12,13]. The techniques for BT, dose and fractionation in the different studies are heterogeneous, which makes direct comparisons difficult.…”

“…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].…”