Intraoperative brachytherapy alone for incomplete resected recurrent rectal cancer

In order to determine the impact of intraoperative brachytherapy alone in patients with recurrent rectal cancer who, due to prior pelvic radiation therapy, were ineligible to receive further external beam pelvic radiation, the authors reviewed the records of 36 patients with recurrent rectal cancers who had gross residual disease remaining in the pelvis following biopsy alone or subtotal resection. The median follow-up was 24 months (6-81 months). The median survival was 27 months and the 4 year actuarial survival was 25 percent. There was a suggestion of lower survival in patients who underwent biopsy alone compared with those who underwent a subtotal resection (21 vs. 34 percent). The local failure (LF) rate was 22 percent as the only site of failure and 44 percent as a component of failure. There was a lower bunt non-significant LF rate in patients who underwent subtotal resection vs. biopsy alone (33 vs. 66 percent) and those with an 125I implant volume of <40 cm3 vs >=40 cm3 (39 vs. 100 percent). Four patients (11 percent) development treatment-related severe complications (without evidence of LF). Our data suggest that, although it is not clear that intraoperative brachytherapy impacts on the ultimate survival rate in this group of patients, it does not offer reasonable local control with acceptable morbidity. Since local control, in and of itself is an important endpoint in treatment of rectal cancer, the authors continue to recommend brachytherapy as part of an overall aggressive approach in patients who are unable to receive pelvic radiation therapy. (author). 37 refs.; 1 fig