Long-Term Survival After High-Dose-Rate Brachytherapy for Locally Advanced or Recurrent Colorectal Adenocarcinoma

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

Research output: Contribution to journalArticle

Abstract

Background: We evaluated outcomes of intraoperative radiotherapy delivered with focal high-dose-rate (HDR) brachytherapy [intraoperative radiotherapy (IORT)] in the management of locally recurrent (LR) and locally advanced (LA) primary T4 colorectal carcinoma (CRC). LR CRC or LA primary disease is a clinical challenge due to the difficulty in obtaining negative margins after radical surgery and the high risk of subsequent recurrence. Few data exist on long-term outcomes of patients treated with surgery and HDR-IORT for LR or LA primary CRC. Methods: Three hundred CRC patients underwent HDR-IORT to the pelvis with gross surgical resection during November 1992–December 2007. Median follow-up for surviving patients was 53 (range 5–216) months. Eighty-eight patients (29 %) were treated for LA primary and 212 (71 %) LR disease. HDR-IORT was delivered using an iridium-192 remote afterloader and a Harrison–Anderson–Mick applicator. Median IORT dose was 1,500 (range 1,000–2,000) cGy. Results: Five-year overall survival probability was 49 %. Positive margin status was associated with inferior overall survival and disease-free survival. Competing-risks analysis for time to local failure and distant metastases identified a 5-year cumulative incidence of local failure and distant metastases of 33 and 47 %, respectively. Five-year cumulative incidence of local failure was 22 % for the LA group and 38 % in the LR group. Five-year probability of disease-free survival was 48 and 31 % for LA and LR patients, respectively, and 5-year probability of overall survival was 56 and 45 % for LA and LR patients, respectively. Conclusions: HDR-IORT combined with resection results in encouraging local control rates with acceptable toxicity for patients with locally aggressive CRC.

Original languageEnglish (US)
Pages (from-to)2168-2178
Number of pages11
JournalAnnals of Surgical Oncology
Volume22
Issue number7
DOIs
StatePublished - Jul 8 2015

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Terezakis, S., Morikawa, L., Wu, A., Zhang, Z., Shi, W., Weiser, M. R., Paty, P. B., Guillem, J., Temple, L., Nash, G. M., Zelefsky, M. J., & Goodman, K. A. (2015). Long-Term Survival After High-Dose-Rate Brachytherapy for Locally Advanced or Recurrent Colorectal Adenocarcinoma. Annals of Surgical Oncology, 22(7), 2168-2178. https://doi.org/10.1245/s10434-014-4271-8