A case of high-dose rate interstitial brachytherapy for locally recurrent rectal cancer

摘要

The patient was a 55-year-old female who underwent an abdomino-perineal resection for advanced lower rectal cancer. The tumor was a well differentiated adenocarcinoma, type 2 in the Japanese classification of colorectal carcinoma, and was measured 2.3 cm in size. Histologically, the tumor was considered to be stage IIIb (mp, n3(+), P0, H0, M(-)). She received adjuvant chemotherapy with 5'-DFUR. After 13 months from the surgery, the patient developed a hip pain. After 16 months from the surgery, a pelvic MRI scan revealed a 3 cm tumor in the perineum. Biopsy from the tumor revealed adenocarcinoma. Consequently, we diagnosed local recurrence in the perineum. Chemotherapy with CPT-11 (230 mg/body) and 5'-DFUR (800 mg/body) was administered for 2 cycles. Because the tumor was enlarged, high-dose rate interstitial brachytherapy was given to the recurrent site at a total dose of 54 Gy/9 fractions/5 days. There were no severe complications. CEA was decreased within normal range from a maximum of 9.3. No progress was detected on CT and MRI, and the hip pain had disappeared. The tumor marker is within normal range for about 2 years and QOL was improved. Hence, high dose rate interstitial brachytherapy appears to be effective for locally recurrent rectal cancer.