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Int J Radiat Oncol Biol Phys. 2019 Dec 1;105(5):1005-1011. doi: 10.1016/j.ijrobp.2019.08.042. Epub 2019 Aug 30.

Image Guided Adaptive Endorectal Brachytherapy in the Nonoperative Management of Patients With Rectal Cancer.

Author information

1
Department of Oncology, Division of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada.
2
Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.
3
Department of Oncology, Division of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Medical Physics Unit, McGill University, Montreal, QC H4A 3J1, Canada.
4
Centre hospitalier universitaire de Québec, Université Laval, Department of Radiation Oncology, Quebec City, QC, Canada.
5
Department of Surgery, Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada.
6
CISSSO, Hôpital de Gatineau, Department of Radiation Oncology, Gatineau, QC, Canada.
7
Hôptial Maisonneuve-Rosemont, Université de Montréal, Department of Radiation Oncology, Montreal, QC, Canada.
8
Hopital Pierre-Boucher, Department of Surgery, Longueuil, QC, Canada.
9
Centre hospitalier de l'Université de Montréal, Department of Surgery, Division of Colon and Rectal Surgery, Montreal, QC, Canada.
10
Department of Oncology, Division of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada. Electronic address: tvuong@jgh.mcgill.ca.

Abstract

PURPOSE:

Organ preservation or nonoperative management of rectal cancer is of growing interest. Image guided adaptive endorectal brachytherapy is a radiation dose escalation modality: we explored its role in elderly patients unfit for surgery and patients refusing surgery.

METHODS AND MATERIALS:

In this registry study, patients with rectal cancer who were ineligible for surgery received 40 Gy in 16 fractions of pelvic external beam radiation therapy. They subsequently received 3 weekly image guided adaptive brachytherapy boosts of 10 Gy to the residual tumor, for a total of 30 Gy in 3 fractions. Complete clinical response (cCR) and local control were the primary endpoints.

RESULTS:

94 patients were included; the median age was 81.1 years. With a median follow-up of 1.9 years, the proportion of cCR was 86.2%, the tumor regrowth proportion was 13.6%, and the cumulative incidence of local relapse was 2.7% at 1 year and 16.8% at 2 years. When considering responders and nonresponders, the 2-year local control was 71.5%. The overall survival at 2 years was 63.6%. Acute rectal grade 1 to 2 toxicity included all patients: 12.8% of patients had late bleeding requiring iron replacement, blood transfusions, or argon plasma therapy.

CONCLUSIONS:

Results of this registry study, evaluating radiation dose escalation for elderly medically unfit patients with unselected tumors, reveal that a high proportion of patients achieved cCR with a manageable toxicity profile. This technology will likely contribute to the challenging nonoperative management paradigm of rectal cancer.

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