Use Of Brachytherapy In Management Of Locally Recurrent Rectal Cancer

PURPOSE: Locally recurrent rectal cancer is associated with poor quality of life and has justified aggressive surgical and adjuvant approaches to control the disease. This study was designed to evaluate if the use of brachytherapy in association with wide surgical excision (debulking operation) can offer reasonable palliation for patients with locally recurrent rectal cancer. MATERIALS AND METHODS: Patients with biopsy-proven locally recurrent rectal cancer who were not candidates for intraoperative radiation therapy and who were previously considered as having unresectable tumors were included in the study and were followed-up from May 1981 to November 1990. All of them had undergone laparotomy and had either radical or debulking surgical resection performed. At the same time, brachytherapy was used with temporary or permanent implant of seeds of iridium-192 or iodine- 125. RESULTS: Thirty patients were included. Patients ranged in age from 28 to 74 years, and 16 patients were female. No mortality was observed, and morbidity was low (small-bowel obstruction (1 patient), intestinal fistula (1 patient), and urinary fistula (1 patient). Histologic examination of the specimen showed gross residual disease in 67 percent of patients and microscopic disease in 25 percent of patients. Long-term follow-up was possible in 28 patients. Mean follow-up and local control were, respectively, 26.5 months and 37.5 percent for gross residual disease and 34 months and 66 percent for microscopic residual disease. Eighteen patients (64 percent) had locally recurrent rectal cancer under control at the time of the last follow- up, with seven patients (25 percent) having no evidence of local or distant recurrence CONCLUSION: This is the first report of brachytherapy for locally recurrent rectal cancer. This appears to offer a therapeutic alternative to patients who are not candidates for intraopetative radiation therapy. Surgical morbidity and mortality are acceptable. Local control in 18 patients (64 percent) is comparable with intraoperative radiation therapy or more morbid surgical alternatives. Cancer-related deaths are most often related to disseminated disease, which suggests the need for systemic therapy in addition to brachytherapy.401011771179Docherty, J.G., McGregor, J.R., O'Dwyer, P.J., Galloway, D.J., Local recurrence of colorectal cancer: The problem, mechanisms, management and adjuvant therapy (1994) Br J Surg, 81, p. 1082Gunderson, L.L., Heart, R.W., O'Connell, M.J., Current issues in the treatment of colorectal cancer (1988) CRC Grit Rev Oncol Hematol, pp. 223-260Gunderson, L.L., Sosin, H., Area of failure found at reoperation following curative surgery for adenocarcinoma of the rectum (1974) Cancer, 34, pp. 1278-1292Moran, M.R., Rothenberger, D.A., Lahr, C.J., Buls, J.G., Goldberg, S.M., Palliation for rectal cancer. Resection? Anastomosis? (1987) Arch Surg, 122, pp. 640-643Wanebo, H.J., Marcove, R.C., Abdominal sacral resection of locally recurrent rectal cancer (1981) Ann Surg, 194, pp. 458-471Suzuki, K., Dozois, R.R., Devine, R.M., Curative reoperations for locally recurrent rectal cancer (1996) Dis Colon Rectum, 39, pp. 730-736Lopez, M.J., Standiford, S.B., Skibba, J.L., Total pelvic exenteration (1994) Arch Surg, 129, pp. 390-396Brodsky, J.T., Sloane, B.B., Khanna, O.P., Total pelvic exenteration with preservation of fecal continence (1993) J Surg Oncol, 53, pp. 261-264Sugarbaker, P.H., Patient selection and treatment of peritoneal carcinomatosis from colorectal and appendiceal cancer (1995) World J Surg, 19, pp. 235-240Bussieres, E., Gilly, F.N., Rouanet, P., Recurrences of rectal cancers: Results of a multimodal approach with intraoperative radiation therapy (1996) Int J Radiat Oncol Biol Phys, 34, pp. 49-56Gunderson, L.L., Cohen, A.M., Dosoretz, D.D., Residual, unresectable, or recurrent colorectal cancer (1983) Int J Radiat Oncol Biol Phys, 9, pp. 1597-1606Tepper, J., Gunderson, L., Orlow, E., Complications of intraoperative radiation therapy (1984) Int J Radiat Oncol Biol Phys, 10, pp. 1831-1839Gunderson, L.L., Marvin, J.K., Nagorney, D.M., Intraoperative irradiation for gastrointestinal cancers: Gastrointestinal cancer (1988) Curr Approaches Diagnosis Treatment, 30, pp. 177-190Magrini, S., Nelson, H., Gunderson, L.L., Sim, F.H., Sacropelvic resection and intraoperative electron irradiation in the management of recurrent anorectal cancer (1996) Dis Colon Rectum, 39, pp. 1-9Makela, J., Haukipuro, K., Laitinene, S., Kairaluoma, M.I., Treatment of recurrent colorectal cancer (1989) Arch Surg, 124, pp. 1029-1032Dubois, G., Screening for colorectal cancer (1995) N Engl J Med, 333, pp. 460-461Aleman, B.M., Bartelink, H., Gunderson, L.L., The current role of radiotherapy in colorectal cancer (1995) Eur J Cancer, 31 A, pp. 1333-133