title: 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.
abstract: OBJECTIVE
  To evaluate the role of interstitial pulsed dose rate brachytherapy (PDR-BT) in multimodality treatment of locally advanced primary or recurrent rectal and sigmoid cancer with high risk of microscopic incomplete resection (R1).
  
  
  METHODS
  A total of 73 consecutive patients (recurrent/primary: 40/33) were treated with PDR-BT between 2001 and 2010. Patients received preoperative external beam radiotherapy (EBRT) and concomitant chemotherapy. Following resection of the tumor and the involved pelvic organs, a median of four (3-8) catheters were sutured to the tumor bed with a distance of approximately 1 cm between the catheters. A target respecting the catheters with a margin of 5 mm was contoured on computed tomography (CT) and three-dimensional (3D) dose planning with a planning aim for BT of D90 > 30 Gy, (0.6 Gy/pulse, 1 pulse/h) was performed. Previously irradiated patients (27%) underwent surgery that was directly followed by PDR-BT. Postoperative EBRT was then applied to the tumor bed 3-5 weeks after PDR-BT.
  
  
  RESULTS
  A total of 23 patients (31%) received a radical resection (R0) and 45 patients (62%) received an R1 resection. Five patients (7%) received a macroscopic incomplete resection (R2). The five-year overall survival was 33%. Local control at five years was 67% for patients who received a R0 resection and 32% for patients who received an R1 resection. The five-year actuarial risk of a grade 3-4 BT-related complication was 5%.
  
  
  CONCLUSIONS
  Meaningful disease control and survival can be obtained at an acceptable rate of late morbidity in selected patients with locally advanced primary and recurrent rectal or sigmoid cancer using (chemo) RT, extensive surgery and PDR-BT when a high risk of an R1 resection is expected.
authors.affiliation: a Department of Surgery , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Mette Bak
authors.initials: MB
authors.lastname: Nielsen
authors.affiliation: a Department of Surgery , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Peter Christian
authors.initials: PC
authors.lastname: Rasmussen
authors.affiliation: b Department of Medical Physics , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Kari
authors.initials: K
authors.lastname: Tanderup
authors.affiliation: b Department of Medical Physics , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Søren Kynde
authors.initials: SK
authors.lastname: Nielsen
authors.affiliation: c Department of Oncology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Fokdal
authors.affiliation: a Department of Surgery , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Laurberg
authors.affiliation: c Department of Oncology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Jacob Christian
authors.initials: JC
authors.lastname: Lindegaard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy / Q000401:mortality*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D012811:Sigmoid Neoplasms / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate