BACKGROUND: Long-term survival and possible cure can be achieved in selected patients after resection of liver metastases from a colorectal primary tumor. In this study, the authors used radioactive implants as adjunctive therapy for patients who had incomplete resections of liver metastases. METHODS: From 1979 to 1990, 17 implants were performed in 12 patients (median age, 61 years). Brachytherapy was performed for microscopically positive margins in 7 implants and for gross residual disease in 10 implants. Volume implants were performed for gross residual disease using 125I seeds, with a median matched peripheral dose of 160 Gy. Most of the implants for microscopic residual disease were planar implants with 125I suture seeds, with a median treatment dose of 150 Gy. RESULTS: There were no serious postoperative complications. Overall median survival was 18 months, and 42% of patients survived 2 years or more. Extrahepatic metastases occurred in 83% of patients (10 of 12). Intrahepatic failure close to the implanted site occurred in 42% of patients (5 of 12), and intrahepatic failure anatomically remote from the implant site occurred in 25% (3 of 12). CONCLUSIONS: This approach is feasible and achieves reasonable local control of residual disease after resection of hepatic metastases from colorectal cancer. The anatomic pattern of failure supports efforts to intensify local therapy and to address the high rate of distant metastases.
BACKGROUND: Long-term survival and possible cure can be achieved in selected patients after resection of liver metastases from a colorectal primary tumor. In this study, the authors used radioactive implants as adjunctive therapy for patients who had incomplete resections of liver metastases. METHODS: From 1979 to 1990, 17 implants were performed in 12 patients (median age, 61 years). Brachytherapy was performed for microscopically positive margins in 7 implants and for gross residual disease in 10 implants. Volume implants were performed for gross residual disease using 125I seeds, with a median matched peripheral dose of 160 Gy. Most of the implants for microscopic residual disease were planar implants with 125I suture seeds, with a median treatment dose of 150 Gy. RESULTS: There were no serious postoperative complications. Overall median survival was 18 months, and 42% of patients survived 2 years or more. Extrahepatic metastases occurred in 83% of patients (10 of 12). Intrahepatic failure close to the implanted site occurred in 42% of patients (5 of 12), and intrahepatic failure anatomically remote from the implant site occurred in 25% (3 of 12). CONCLUSIONS: This approach is feasible and achieves reasonable local control of residual disease after resection of hepatic metastases from colorectal cancer. The anatomic pattern of failure supports efforts to intensify local therapy and to address the high rate of distant metastases.