PURPOSE: Management of locally recurrent colorectal adenocarcinoma represents a significant challenge. Many of these tumors adhere to or invade into vital pelvic structures rendering surgery or external beam radiotherapy (EBRT) as palliative treatment. Therefore, a treatment approach was developed to evaluate the role of high-dose-rate intraoperative brachytherapy (HDR-IORT) and surgery as a component of therapy in the management of locally recurrent colorectal cancer. This is an update of our preliminary report with longer follow-up and larger patient numbers. METHODS AND MATERIALS: Between January 1992 and September 1998, 74 patients with locally recurrent rectal cancer were treated with surgery and HDR-IORT. Additional EBRT was given to 29 patients, and 33 patients received 5-fluorouracil based chemotherapy. All patients underwent complete gross resection, and 21 of 74 had positive microscopic margin. The dose of HDR-IORT ranged from 10 to 18 Gy. RESULTS: With a median follow-up of 22 months, the 5-year local control, distant metastasis disease-free, disease-free, and overall survival rates were 39%, 39%, 23%, and 23%, respectively. The only predictor of improved local control was a negative margin of resection with a 5-year local control rate of 43%, compared to 26% in those with positive margin (p = 0.02). For overall survival, a negative microscopic margin (p = 0.04) and the use of IORT + EBRT (p = 0.04) were significant predictors of improved survival. The incidence of peripheral neuropathy was 16%. CONCLUSION: The results with HDR-IORT in this group of patients are encouraging. Further improvements in local and distant control are still needed.
PURPOSE: Management of locally recurrent colorectal adenocarcinoma represents a significant challenge. Many of these tumors adhere to or invade into vital pelvic structures rendering surgery or external beam radiotherapy (EBRT) as palliative treatment. Therefore, a treatment approach was developed to evaluate the role of high-dose-rate intraoperative brachytherapy (HDR-IORT) and surgery as a component of therapy in the management of locally recurrent colorectal cancer. This is an update of our preliminary report with longer follow-up and larger patient numbers. METHODS AND MATERIALS: Between January 1992 and September 1998, 74 patients with locally recurrent rectal cancer were treated with surgery and HDR-IORT. Additional EBRT was given to 29 patients, and 33 patients received 5-fluorouracil based chemotherapy. All patients underwent complete gross resection, and 21 of 74 had positive microscopic margin. The dose of HDR-IORT ranged from 10 to 18 Gy. RESULTS: With a median follow-up of 22 months, the 5-year local control, distant metastasis disease-free, disease-free, and overall survival rates were 39%, 39%, 23%, and 23%, respectively. The only predictor of improved local control was a negative margin of resection with a 5-year local control rate of 43%, compared to 26% in those with positive margin (p = 0.02). For overall survival, a negative microscopic margin (p = 0.04) and the use of IORT + EBRT (p = 0.04) were significant predictors of improved survival. The incidence of peripheral neuropathy was 16%. CONCLUSION: The results with HDR-IORT in this group of patients are encouraging. Further improvements in local and distant control are still needed.
Authors: Amar U Kishan; Justin C Voog; Jonathan Wiseman; Ryan R Cook; Marek Ancukiewicz; Percy Lee; David P Ryan; Jeffrey W Clark; David L Berger; James C Cusack; Jennifer Y Wo; Theodore S Hong Journal: Br J Radiol Date: 2017-06-14 Impact factor: 3.039
Authors: Stephanie Terezakis; Lisa Morikawa; Abraham Wu; Zhigang Zhang; Weiji Shi; Martin R Weiser; Philip B Paty; Jose Guillem; Larissa Temple; Garrett M Nash; Michael J Zelefsky; Karyn A Goodman Journal: Ann Surg Oncol Date: 2015-01-29 Impact factor: 5.344
Authors: Gil'ad N Cohen; Karen Episcopia; Seng-Boh Lim; Thomas J LoSasso; Mark J Rivard; Amandeep S Taggar; Neil K Taunk; Abraham J Wu; Antonio L Damato Journal: Brachytherapy Date: 2017-08-18 Impact factor: 2.362
Authors: Andre A Konski; W Warren Suh; Joseph M Herman; A William Blackstock; Theodore S Hong; Matthew M Poggi; Miguel Rodriguez-Bigas; William Small; Charles R Thomas; Jennifer Zook Journal: Gastrointest Cancer Res Date: 2012-01