High dose rate intraluminal brachytherapy in combination with external beam radiotherapy for palliative treatment of cancer rectum

To evaluate the feasibility, efficacy and toxicity of High Dose Rate Intraluminal Brachytherapy [HDRILB] in combination with External Beam Radiotherapy [EBR] used in the palliative treatment of selected patients of adenocarcinoma rectum. Design: A prospective pilot study. Place and Duration of Study: The study was conducted at the Institute of Radiotherapy and Nuclear Medicine [IRNUM], Peshawar. The study started in April 1996 and the patients' accrual was completed in June 1997. Patients and The patients with adenocarcinoma rectum, who refused surgery, had contraindications for surgery or had advanced and/or metastatic disease were treated with HDRILB in combination with external beam radiotherapy [EBR]. The apparatus used for HDRILB was Ralstron 20B remote afterloading unit with 60Co stepping source. Indigenously designed rectal applicators were used. The EBR was delivered through Pheonix 60Co teletherapy machine [Theratron AECL]. The data for symptom burden and symptomatic relief was analyzed by applying Likert's method of summated scales. Data was analyzed after one week and at the end of the treatment. After one week of treatment, the relief in pain and bleeding per rectum [P/R] was 97%. Excellent palliation was achieved at the end of the treatment when perineal pain and bleeding P/R were relieved in 100%, discharge P/R in 87% and tenesmus in 93% of the cases. Conclusion:The use of HDRILB in combination with EBR can provide quick relief of symptoms in selected patients of adenocarcinoma rectum. This combination has an excellent palliative value because of its effectiveness, acceptable toxicity and overall short treatment duration

Recurrent rectal carcinoma treated with high dose rate intraluminal brachy therapy

A 65 years old man with recurrent rectal cancer was treated with remote afterloading High Dose Rate Intraluminal Brachytherapy [HDRILB]. After eight weeks of HDRILB there was complete regression of the tumor. Bleeding per rectum and pain in the perineum were greatly improved. He died of myocardial infarction after 41 months of treatment with HDRILB. The treated lesions were incomplete remission at the time of death. The procedure was well tolerated. The only treatment-associated toxicity was grade 2 proctitis, which was treated conservatively. HDRILB can be used as one of the treatment options in patients with recurrent rectal cancers who have undergone previous abdominal surgery and external beam irradiation, as exhibited in our limited experience