Morimoto Masahiro, Isohashi Fumiaki, Yoshioka Yasuo, Suzuki Osamu, Seo Yuji, Ogata Toshiyuki, Akino Yuichi, Koizumi Masahiko, Ogawa Kazuhiko
Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka, 565-0871, Japan.
Int J Clin Oncol. 2014 Apr;19(2):312-8. doi: 10.1007/s10147-013-0567-0. Epub 2013 Jun 1.
We retrospectively examined outcomes of salvage high-dose-rate interstitial brachytherapy (HDR-ISBT) for locally recurrent rectal cancer (LRRC).
Nine patients with LRRC were treated with salvage HDR-ISBT. Their median age was 63 years. The median maximum diameter of LRRC was 40 mm (range 20-80 mm). Adenocarcinomas were histologically confirmed in all cases. The prescribed dose was 30 Gy/5 fractions/3 days to 50 Gy/10 fractions/6 days in the combined external-beam radiotherapy group (four patients) and 54 Gy/9 fractions/5 days to 60 Gy/10 fractions/6 days in the monotherapeutic group (five patients). Median follow-up time was 90 months (range 6-221 months).
Local control at final follow-up was achieved in five of nine patients. Of these five patients, one experienced a locally re-recurrent tumor in the vaginal wall 33 months after treatment and received re-HDR-ISBT as re-salvage treatment. The 8-year overall survival, local control, and progression-free survival rates were 56, 44, and 33 %, respectively. Based on the Common Terminology Criteria for Adverse Events ver. 4.03, the following Grade 3 adverse events were observed in three patients (≥3 months): Grade 3 skin ulceration in one patient who showed tumor invasion of the skin and whose V100 was 400 cc; Grade 3 vaginal perforation in one patient whose tumor had invaded the vaginal wall; and Grade 3 vagina-to-bladder fistula in one patient whose tumor received re-irradiation. Late adverse events above Grade 3 were not observed.
Long-term follow-up results revealed that salvage HDR-ISBT is a promising treatment for LRRC with tolerable toxicity.
我们回顾性研究了挽救性高剂量率组织间近距离放射治疗（HDR-ISBT）用于局部复发性直肠癌（LRRC）的疗效。
9例LRRC患者接受了挽救性HDR-ISBT治疗。他们的中位年龄为63岁。LRRC的中位最大直径为40mm（范围20-80mm）。所有病例均经组织学确诊为腺癌。联合外照射放疗组（4例患者）的处方剂量为30Gy/5次/3天至50Gy/10次/6天，单纯治疗组（5例患者）的处方剂量为54Gy/9次/5天至60Gy/10次/6天。中位随访时间为90个月（范围6-221个月）。
9例患者中有5例在最后随访时实现了局部控制。在这5例患者中，1例在治疗后33个月阴道壁出现局部复发肿瘤，并接受了再次HDR-ISBT作为挽救性治疗。8年总生存率、局部控制率和无进展生存率分别为56%、44%和33%。根据不良事件通用术语标准第4.03版，3例患者（≥3个月）出现了以下3级不良事件：1例肿瘤侵犯皮肤且V100为400cc的患者出现3级皮肤溃疡；1例肿瘤侵犯阴道壁的患者出现3级阴道穿孔；1例肿瘤接受再次照射的患者出现3级阴道膀胱瘘。未观察到3级以上的晚期不良事件。
长期随访结果显示，挽救性HDR-ISBT是一种治疗LRRC且毒性可耐受的有前景的治疗方法。
