USE OF BRACHYTHERAPY IN MANAGEMENT OF LOCALLY RECURRENT RECTAL-CANCER

PURPOSE: Locally recurrent rectal cancer is associated with poor quali ty of life and has justified aggressive surgical and adjuvant approach es to control the disease. This study was designed to evaluate if the use of brachytherapy in association with wide surgical excision (debul king operation) can offer reasonable palliation for patients with loca lly recurrent rectal cancer. MATERIALS AND METHODS: Patients with biop sy-proven locally recurrent rectal cancer who were not candidates for intraoperative radiation therapy and who were previously considered as having unresectable tumors were included in the study and were follow ed-up from Map 1981 to November 1990. All of them had undergone laparo tomy and had either radical or debulking surgical resection performed. At the same time, brachytherapy was used with temporary or permanent implant of seeds of iridium-192 or iodine-125. RESULTS: Thirty patient s were included. Patients ranged in age from 28 to 74 years, and 16 pa tients were female. No mortality was observed, and morbidity was low ( small-bowel obstruction (1 patient), intestinal fistula (1 patient), a nd urinary fistula (1 patient). Histologic examination of the specimen showed gross residual disease in 67 percent of patients and microscop ic disease in 25 percent of patients. Long-term follow-up was possible in 28 patients. Mean follow-up and local control were, respectively, 26.5 months and 37.5 percent for gross residual disease and 34 months and 66 percent for microscopic residual disease. Eighteen patients (64 percent) had locally recurrent rectal cancer under control at the tim e of the last follow-up, with seven patients (25 percent) having no ev idence of local or distant recurrence. CONCLUSION: This is the first r eport of brachytherapy for locally recurrent rectal cancer. This appea rs to offer a therapeutic alternative to patients who are not candidat es for intraoperative radiation therapy. Surgical morbidity and mortal ity are acceptable. Local control in 18 patients (64 percent) is compa rable with intraoperative radiation therapy or more morbid surgical al ternatives. Cancer-related deaths are most often related to disseminat ed disease, which suggests the need for systemic therapy in addition t o brachytherapy.