title: Palliative interstitial HDR brachytherapy for recurrent rectal cancer. Implantation techniques and results.
abstract: OBJECTIVE
  To report the methods and clinical results of CT-based interstitial high-dose-rate (HDR) brachytherapy procedures for the palliative treatment of recurrent rectal cancer.
  
  
  METHODS
  A total of 44 brachytherapy implants were performed in 38 patients. CT-guided catheter implants were performed in 34 patients under local anesthesia and sedation, and four patients were implanted intraoperatively. Of 40 CT-guided implants, 20 were done using metallic needles introduced via the sacrum and 20 were transperineal implants of plastic tubes in the presacral region. Postimplant CT scans were used for three-dimensional (3-D) conformal brachytherapy planning. Patients implanted with metallic needles were given a single fraction of 10-15 Gy using HDR (192)Ir, and those who received transperineal implants of plastic catheters were given fractionated brachytherapy, 5 Gy twice daily to a total dose of 30-40 Gy. The median tumor volume was 225 cm(3) with a range of 41-2,103 cm(3).
  
  
  RESULTS
  After a median follow-up of 23.4 months, a total of 13/38 patients were alive. The median postbrachytherapy survival was 15 months with 18 of the 25 deaths due to distant metastases. Tumor response was as follows: 6/38 partial remission, 28/38 stable disease, and 4/38 local progression. A planning target volume (PTV) coverage > 85% was achieved in 42/44 implants. The treatment was well tolerated, and no acute complications were observed. One patient developed a fistula after 8 months. Pain relief was recorded in 34 patients (89.5%), and the median duration of this palliative effect was 5 months with a range of 1-13 months.
  
  
  CONCLUSIONS
  Interstitial HDR brachytherapy is a valuable tool for the delivery of high doses and achieves effective palliation in recurrent rectal carcinoma.
authors.affiliation: Department of Radiation Oncology, Offenbach Hospital, Offenbach, Germany.
authors.forename: Christos
authors.initials: C
authors.lastname: Kolotas
authors.forename: Sandra
authors.initials: S
authors.lastname: Röddiger
authors.forename: Gerd
authors.initials: G
authors.lastname: Strassmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Martin
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tselis
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Aebersold
authors.forename: Dimos
authors.initials: D
authors.lastname: Baltas
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Zamboglou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D010166:Palliative Care / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D011882:Radiotherapy, High-Energy / Q000295:instrumentation*; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000295:instrumentation