Stoian Raluca, Neeff Hannes P, Gainey Mark, Kollefrath Michael, Kirste Simon, Zamboglou Constantinos, Exner Jan Philipp Harald, Baltas Dimos, Fichtner Feigl Stefan, Grosu Anca-Ligia, Sprave Tanja
Department of Radiation Oncology, University Hospital of Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany.
German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Neuenheimer Feld 280, 69120, Heidelberg, Germany.
Strahlenther Onkol. 2025 Jan;201(1):27-35. doi: 10.1007/s00066-024-02271-1. Epub 2024 Aug 8.
Locally advanced recurrent rectal cancer (RRC) requires a multimodal approach. Intraoperative high-dose-rate brachytherapy (HDR-BT) may reduce the risk of local recurrence. However, the optimal therapeutic regimen remains unclear. The aim of this retrospective monocentric study was to evaluate the toxicity of HDR-BT after resection of RRC.
Between 2018 and 2022, 17 patients with RRC received resection and HDR-BT. HDR-BT was delivered alone or as an anticipated boost with a median dose of 13 Gy (range 10-13 Gy) using an iridium microSelectron HDR remote afterloader (Elekta AB, Stockholm, Sweden). All participants were followed for assessment of acute and late adverse events using the Common Terminology Criteria for Adverse Events version 5.0 and the modified Late Effects in Normal Tissues criteria (subjective, objective, management, and analytic; LENT-SOMA) at 3‑ to 6‑month intervals.
A total of 17 patients were treated by HDR-BT with median dose of 13 Gy (range 10-13 Gy). Most patients (47%) had an RRC tumor stage of cT3‑4 N0. At the time of RRC diagnosis, 7 patients (41.2%) had visceral metastases (hepatic, pulmonary, or peritoneal) in the sense of oligometastatic disease. The median interval between primary tumor resection and diagnosis of RRC was 17 months (range 1-65 months). In addition to HDR-BT, 2 patients received long-course chemoradiotherapy (CRT; up to 50.4 Gy in 1.8-Gy fractions) and 2 patients received short-course CRT up to 36 Gy in 2‑Gy fractions. For concomitant CRT, all patients received 5‑fluorouracil (5-FU) or capecitabine. Median follow-up was 13 months (range 1-54). The most common acute grade 1-2 toxicities were pain in 7 patients (41.2%), wound healing disorder in 3 patients (17.6%), and lymphedema in 2 patients (11.8%). Chronic toxicities were similar: grade 1-2 pain in 7 patients (41.2%), wound healing disorder in 3 patients (17.6%), and incontinence in 2 patients (11.8%). No patient experienced a grade ≥3 event.
Reirradiation using HDR-BT is well tolerated with low toxicity. An individualized multimodality approach using HDR-BT in the oligometastatic setting should be evaluated in prospective multi-institutional studies.
局部进展期复发性直肠癌（RRC）需要多模式治疗方法。术中高剂量率近距离放疗（HDR-BT）可能会降低局部复发风险。然而，最佳治疗方案仍不明确。这项回顾性单中心研究的目的是评估RRC切除术后HDR-BT的毒性。
2018年至2022年期间，17例RRC患者接受了切除及HDR-BT治疗。HDR-BT单独进行或作为预期增敏治疗，使用铱微型Selectron HDR遥控后装治疗机（瑞典斯德哥尔摩的医科达公司），中位剂量为13 Gy（范围10 - 13 Gy）。所有参与者每隔3至6个月接受随访，使用不良事件通用术语标准第5.0版和改良的正常组织晚期效应标准（主观、客观、管理和分析；LENT-SOMA）评估急性和晚期不良事件。
共有17例患者接受了HDR-BT治疗，中位剂量为13 Gy（范围10 - 13 Gy）。大多数患者（47%）的RRC肿瘤分期为cT3-4 N0。在RRC诊断时，7例患者（41.2%）存在寡转移疾病意义上的内脏转移（肝、肺或腹膜）。原发性肿瘤切除与RRC诊断之间的中位间隔为17个月（范围1 - 65个月）。除HDR-BT外，2例患者接受了长程放化疗（CRT；1.8 Gy分割，剂量高达50.4 Gy），2例患者接受了短程CRT，2 Gy分割，剂量高达36 Gy。对于同步CRT，所有患者均接受5-氟尿嘧啶（5-FU）或卡培他滨。中位随访时间为13个月（范围1 - 54个月）。最常见的1-2级急性毒性反应为7例患者（41.2%）出现疼痛，3例患者（17.6%）出现伤口愈合障碍，2例患者（11.8%）出现淋巴水肿。慢性毒性反应类似：7例患者（41.2%）出现1-2级疼痛，3例患者（17.6%）出现伤口愈合障碍，2例患者（11.8%）出现失禁。没有患者发生≥3级事件。
使用HDR-BT进行再照射耐受性良好，毒性较低。应在前瞻性多机构研究中评估在寡转移情况下使用HDR-BT的个体化多模式治疗方法。
