High-dose-rate brachytherapy of recurrent rectal adenocarcinoma presenting as a solitary intravascular metastasis of the iliac vein: A case report

Purpose To describe a novel use of high-dose-rate intravascular brachytherapy in the first reported case of macroscopic metastatic rectal adenocarcinoma within a peripheral vein. Methods and materials Following thrombolytic therapy to ablate an overlying venous thrombosis, a vascular stent was deployed across the entire length of the tumor. Using the stent as a target, 4300 cGy was delivered to the tumor via megavoltage external beam radiation. This was followed by two weekly intravascular high-dose-rate 192Ir brachytherapy applications of 400 cGy each. Results There is no evidence of recurrence in the treated vein at 43 months of follow-up. Conclusions In this unique case, a combination of external beam radiation therapy and intravascular brachytherapy provided effective control of a solitary intravascular metastasis from rectal carcinoma.