Intraoperative high-dose-rate brachytherapy (IBT) for locally unresectable intraabdominal malignancy

Intraoperative high-dose-rate brachytherapy (IBT) has been successfully used in locally advanced unresectable intraabdominal malignancy. We retrospectively evaluated the safety, feasibility, and general outcome of IBT following cytoreductive surgery.

After radical resection, the target area to be treated by IBT was determined jointly by the surgeon and the radiation oncologist. A silicon template was used to position parallel hollow catheters spaced 1 cm apart against the area of interest. IBT doses were prescribed at 1 cm depth from the template surface and calculated using standard plans. Radiation was administered in a dedicated shielded room.

Between August 2001 and February 2006, 10 patients (colorectal cancer n = 6, cervix cancer n = 1, extramedullar plasmocytoma n = 1, liposarcoma n = 1 and sacrococcygeal teratocarcinoma n = 1) were treated. The mean delivered IBT dose was 8 Gy (range 7.5-20). No postoperative mortality was seen, while major complications developed in one (10%) patient with a rectovaginal fistula and intraabdominal abscess. Five of the six colorectal cancer patients developed local recurrence while 3 also developed distant metastases. The mean disease-free and overall survival in this group was 8.5 months (range 4-15) and 25.5 months (range 10-48) respectively. Palliation of symptoms was observed in 89 % of cases.

IBT combined with debulking surgery is feasible and can be safely performed. While cure is rarely achieved, IBT offers the potential to prolong local control and survival in locally unresectable intraabdominal cancer. Therefore, IBT can be considered as a valuable adjuvant in the therapeutic and palliative armamentarium in these selected patients.