CT-guided radioactive seed implantation for recurrent rectal carcinoma after multiple therapy.
The recurrent carcinoma has been difficult to manage after surgery and radiotherapy, extensive resection of locally recurrent rectal cancer is associated with significant morbidity and mortality. Re-irradiation, even in combination with chemotherapy has shown very short survival. We assess the feasibility and efficacy of CT-guided interstitial permanent brachytherapy with (125)I or (103)Pd seeds for recurrent rectal cancer after multiple treatments. Fifteen patients with locally recurrent rectal carcinoma received (125)I or (103)Pd seed implants under CT guidance. The minimal peripheral dose of seed implants was 110-165 Gy (median 150 Gy). Two weeks after seed implantation, a 50 Gy of stereotactic radiotherapy was given to one patient; four patients received 2-4 cycles of chemotherapy. A median follow-up was 8 months (range 4-50 months). The duration of pain-free survival was 0-50 months (median 7 months). Local control was maintained for 3-50 months (median 7 months). The 1- and 2-year local controls were 16.2 and 8.1%, respectively. Eleven patients died: two (18.2%) of local recurrence, seven (63.6%) of local recurrence and metastases, and two (18.2%) of metastases. Four patients (26.7%) survived the median survival was 9 months. The 1- and 2-year actuarial overall survival rates were 42.9% and 10.7%, respectively. One patient (7.6%) experienced a grade 4 toxic event; there was no associated neuropathy. CT-guided radioactive seed implantation is feasible and safe as a salvage or palliative pain relief treatment for patients with recurrent rectal cancers after surgery and radiotherapy.
Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Huayuan North Road No 49, Haidian District, Beijing 100083, China. doctorwangjunjie@yahoo.com.cn
Jun Jie
JJ
Wang
Hui Shu
HS
Yuan
Jin Na
JN
Li
Yu Liang
YL
Jiang
Su Qing
SQ
Tian
Rui Jie
RJ
Yang
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D007457:Iodine Radioisotopes