CT-based adaptive high-dose-rate endorectal brachytherapy in the preoperative treatment of locally advanced rectal cancer: Technical and practical aspects

R A Nout; S Devic; T Niazi; J Wyse; M Boutros; V Pelsser; T Vuong

doi:10.1016/j.brachy.2016.03.004

CT-based adaptive high-dose-rate endorectal brachytherapy in the preoperative treatment of locally advanced rectal cancer: Technical and practical aspects

Brachytherapy. 2016 Jul-Aug;15(4):477-484. doi: 10.1016/j.brachy.2016.03.004. Epub 2016 Apr 16.

Authors

R A Nout¹, S Devic², T Niazi³, J Wyse⁴, M Boutros⁵, V Pelsser⁶, T Vuong⁷

Affiliations

¹ Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
² Department of Radiation Oncology, Jewish General Hospital, McGill University, Montréal, Québec, Canada; Medical Physics Unit, McGill University, Montréal, Québec, Canada.
³ Department of Radiation Oncology, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
⁴ Division of Gastroenterology, Department of Medicine, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
⁵ Department of Surgery, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
⁶ Department of Radiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
⁷ Department of Radiation Oncology, Jewish General Hospital, McGill University, Montréal, Québec, Canada. Electronic address: tvuong@jgh.mcgill.ca.

PMID: 27090225
DOI: 10.1016/j.brachy.2016.03.004

Abstract

Purpose: During the last decade due to the availability of a CT scan in the brachytherapy suite, high-dose-rate endorectal brachytherapy (HDREBT) has evolved as a CT-based daily adaptive treatment. An update of the technical and practical aspects of HDREBT is provided.

Methods and materials: Description of technical and practical aspects of HDREBT focused on the preoperative treatment of locally advanced rectal cancer. During preoperative HDREBT, 26 Gy is delivered in four daily applications of 6.5 Gy prescribed to the 100% isodose, covering the clinical target volume. Daily CT scans are obtained and used for plan optimization, leaving patient positioning unchanged between CT scan and treatment delivery.

Results: All steps of HDREBT treatment procedure are discussed in detail: flexible proctosigmoidoscopy and clipping; patient setup; applicator placement; target delineation; treatment planning and delivery; and patient care. Afterward, treatment results are reviewed.

Conclusions: CT-based adaptive preoperative HDREBT is a practical and feasible therapy for locally advanced rectal cancer, offering excellent local control with a favorable toxicity profile.

Keywords: Adaptive radiotherapy; Brachytherapy; Preoperative radiotherapy; Rectal cancer.

MeSH terms

Brachytherapy / methods*
Digestive System Surgical Procedures
Humans
Neoadjuvant Therapy*
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted / methods*
Rectal Neoplasms / pathology
Rectal Neoplasms / radiotherapy*
Sigmoidoscopy
Tomography, X-Ray Computed / methods
Treatment Outcome