title: Long-Term Survival After High-Dose-Rate Brachytherapy for Locally Advanced or Recurrent Colorectal Adenocarcinoma.
abstract: BACKGROUND
  We evaluated outcomes of intraoperative radiotherapy delivered with focal high-dose-rate (HDR) brachytherapy [intraoperative radiotherapy (IORT)] in the management of locally recurrent (LR) and locally advanced (LA) primary T4 colorectal carcinoma (CRC). LR CRC or LA primary disease is a clinical challenge due to the difficulty in obtaining negative margins after radical surgery and the high risk of subsequent recurrence. Few data exist on long-term outcomes of patients treated with surgery and HDR-IORT for LR or LA primary CRC.
  
  
  METHODS
  Three hundred CRC patients underwent HDR-IORT to the pelvis with gross surgical resection during November 1992-December 2007. Median follow-up for surviving patients was 53 (range 5-216) months. Eighty-eight patients (29 %) were treated for LA primary and 212 (71 %) LR disease. HDR-IORT was delivered using an iridium-192 remote afterloader and a Harrison-Anderson-Mick applicator. Median IORT dose was 1,500 (range 1,000-2,000) cGy.
  
  
  RESULTS
  Five-year overall survival probability was 49 %. Positive margin status was associated with inferior overall survival and disease-free survival. Competing-risks analysis for time to local failure and distant metastases identified a 5-year cumulative incidence of local failure and distant metastases of 33 and 47 %, respectively. Five-year cumulative incidence of local failure was 22 % for the LA group and 38 % in the LR group. Five-year probability of disease-free survival was 48 and 31 % for LA and LR patients, respectively, and 5-year probability of overall survival was 56 and 45 % for LA and LR patients, respectively.
  
  
  CONCLUSIONS
  HDR-IORT combined with resection results in encouraging local control rates with acceptable toxicity for patients with locally aggressive CRC.
authors: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors: Stephanie
authors: S
authors: Terezakis
authors: Lisa
authors: L
authors: Morikawa
authors: Abraham
authors: A
authors: Wu
authors: Zhigang
authors: Z
authors: Zhang
authors: Weiji
authors: W
authors: Shi
authors: Martin R
authors: MR
authors: Weiser
authors: Philip B
authors: PB
authors: Paty
authors: Jose
authors: J
authors: Guillem
authors: Larissa
authors: L
authors: Temple
authors: Garrett M
authors: GM
authors: Nash
authors: Michael J
authors: MJ
authors: Zelefsky
authors: Karyn A
authors: KA
authors: Goodman
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary; D001918:Brachytherapy / Q000401:mortality*; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary; D011379:Prognosis; D011879:Radiotherapy Dosage; D015996:Survival Rate; D013997:Time Factors
references: Cancer. 1995 Feb 15;75(4):939-52
references: 7531113
references: Dis Colon Rectum. 1996 Dec;39(12):1379-95
references: 8969664
references: Ann Surg. 1987 May;205(5):482-95
references: 2437869
references: Radiother Oncol. 1998 Nov;49(2):169-74
references: 10052883
references: Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):219-26
references: 10924992
references: Int J Radiat Oncol Biol Phys. 1998 Sep 1;42(2):325-30
references: 9788411
references: Cancer. 1983 Sep 1;52(5):814-8
references: 6871823
references: Ann Surg. 1987 Jan;205(1):41-4
references: 3800461
references: J Surg Oncol. 1995 Oct;60(2):122-7
references: 7564378
references: Int J Radiat Oncol Biol Phys. 1984 Oct;10(10):1831-9
references: 6436198
references: Int J Radiat Oncol Biol Phys. 2004 Jan 1;58(1):106-12
references: 14697427
references: J Surg Oncol. 1993 May;53(1):20-9
references: 8479193
references: Ann Surg. 2008 Oct;248(4):592-8
references: 18936572
references: Radiother Oncol. 2002 Feb;62(2):201-6
references: 11937247
references: Ann Surg Oncol. 2008 Jul;15(7):1937-47
references: 18389321
references: Ann Surg. 1998 Aug;228(2):194-200
references: 9712564
references: Med Dosim. 1997 Summer;22(2):83-6
references: 9243458
references: Int J Radiat Oncol Biol Phys. 1997 Feb 1;37(3):601-14
references: 9112459
references: Radiother Oncol. 2001 Jan;58(1):83-7
references: 11165686
references: Radiother Oncol. 2011 Mar;98(3):298-303
references: 21339010
references: Int J Radiat Oncol Biol Phys. 1996 Jan 1;34(1):49-56
references: 12125680
references: J Surg Oncol. 1993 May;53(1):30-5
references: 8479194
references: Radiother Oncol. 2002 Feb;62(2):207-13
references: 11937248
references: Acta Chir Iugosl. 2004;51(3):11-8
references: 16018360
references: J Surg Oncol. 1999 Oct;72(2):66-71
references: 10518101
references: Dis Colon Rectum. 1983 Jan;26(1):30-6
references: 6822158
references: Ann Surg. 1981 Oct;194(4):458-71
references: 7283507
references: Eur J Surg Oncol. 2004 Sep;30(7):750-8
references: 15296989
references: Int J Radiat Oncol Biol Phys. 1997 Jul 1;38(4):777-83
references: 9240646
references: Int J Radiat Oncol Biol Phys. 2011 Jan 1;79(1):143-50
references: 20395067
references: Brachytherapy. 2013 Jan-Feb;12(1):1-7
references: 23167979
references: Int J Radiat Oncol Biol Phys. 1994 Sep 30;30(2):419-25
references: 7523346