Re-irradiation using Permanent Interstitial Brachytherapy (PIB): A Potentially Durable Technique for Salvaging Recurrent Pelvic Malignancies

Publication date: Available online 26 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Jonathan Feddock, Dennis Cheek, Cole Steber, Jason Edwards, Stacey Slone, Wei Luo, Marcus Randall
PurposeWomen who develop recurrence of malignancy in a previously irradiated pelvis are often considered incurable. Permanent interstitial brachytherapy (PIB) is an under-utilized but well-tolerated and safe treatment option with significant curative potential when utilized in well-selected patients.Materials and methodsForty-two previously irradiated patients received curative or palliative intent PIB for a recurrent pelvic malignancy between January 2009 and August 2016. Minimum follow-up was 6 months following the PIB procedure. All patients had a biopsy-proven recurrence and were treated using PIB alone (n=32) or in combination with a short course of additional radiation therapy (n=10). Competing risk analyses were performed to assess the risk of failures in the presence of death without failure. Exploratory analyses were performed for factors related to failure using competing risk analyses and the Gray statistic.ResultsA total of 61 PIB implants were performed among 42 patients with a median follow up of 16.3 months. Fifty-two implants were performed as the first salvage re-irradiation to a solitary recurrence (8 patients had more than one lesion), and the success rate for initial re-irradiation using PIB was 73% (38 cases out of 52), and the median TTF was not reached. Nine patients underwent a second repeat PIB to the same recurrence as a form of salvage – 3 (33%) remain without evidence of recurrence. The median TTF after second salvage was 7.7 months. Even with the limited sample size, prolonged TTF was marginally associated with definitive intent (p=0.07) and the extent of disease at the time of PIB (p=0.08). Grade 3+ toxicities were seen in 8 patients (16.7%).ConclusionsPermanent interstitial brachytherapy is a feasible and potentially durable treatment modality that can be used to curatively salvage selected recurrent pelvic malignancies in a previously irradiated field.

Teaser

Permanent interstitial brachytherapy (PIB) is an often forgotten and underutilized brachytherapy technique that can be used to manage small volume recurrent gynecologic disease. The primary intent of this type of treatment is to manage local disease, and in nearly all cases, curative doses of radiation can be delivered in a single outpatient procedure. The median time to failure for re-irradiation was not identified in this series suggesting its effectiveness as a form of local therapy.


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