PRELIMINARY-RESULTS OF A PHASE I II STUDY OF POSTOPERATIVE HIGH-DOSE-RATE BRACHYTHERAPY FOR ADVANCED OR RECURRENT PELVIC TUMORS/

Electron beam intraoperative radiation therapy (EB-IORT) and intraoper ative low-dose rate brachytherapy (IOLB) seem able to improve the loca l control of advanced or recurrent pelvic tumors (ARPT). We report the usefulness, technical considerations and potential advantages of empl oying post-operative high-dose rate brachytherapy (POHB) as a treatmen t for ARPT. From February 1995 to February I997, 14 patients underwent POHB for ARPT. The mean age was 58 years (range:37-74). Six patients presented with recurrent rectal carcinoma, three with cervix carcinoma (one primary T3;two recurrences), two with bladder carcinoma (one pri mary T4;one recurrence), one with prostate carcinoma, one with recurre nt pre-sacral lymphoma and one with undifferentiated carcinoma. At the time of resection, blind-end HDR catheters were implanted in a single plan in the tumour bed and stabilized by absorbable sutures. Eight da ys later, POHB delivered 20Gy in 5 fractions of 40Gy in 10 fractions f or advanced and recurrent tumours, respectively. To decrease the incid ence of late side-effects, a change was made after the tenth patient t o deliver 2Gy per fraction twice a day with an interval of 6h between each fraction. With a median follow-up of 8 months (range:1-22), local control was achieved in all cases. Six patients developed metastic di sease. One patient presented a perineal wound dehiscence requiring sur gery 2 months after POHB. POHB is feasible for patients with recurrent or advanced pelvic diseases, and appears more cost-effective than EB- IORT for dosimetric and radiobiological considerations. Compared with IOLB, POHB allows the total radioprotection of the medical staff, and, in the context of cost reduction, a reduction of the overall time of hospitalization.