Planned organ preservation for elderly patients with rectal cancer using short course radiotherapy and a contact brachytherapy boost-an International multi-institution analysis.
Contact X-ray brachytherapy
Organ Preservation
Papillon technique
Rectal cancer
Short course radiotherapy
Journal
Clinical and translational radiation oncology
ISSN: 2405-6308
Titre abrégé: Clin Transl Radiat Oncol
Pays: Ireland
ID NLM: 101713416
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
received:
02
12
2022
revised:
06
01
2023
accepted:
09
01
2023
entrez:
23
1
2023
pubmed:
24
1
2023
medline:
24
1
2023
Statut:
epublish
Résumé
The use of external beam radiotherapy (EBRT) and contact X-Ray brachytherapy (CXB) is emerging as an effective alternative in patients with early stage rectal cancer with the intent of organ preservation (OP). Short course radiotherapy (SCRT) is an alternative EBRT schedule for patients not fit for chemotherapy or for longer courses of EBRT. There are no multicentre studies that have reported on the outcomes of SCRT with a CXB boost, therefore we present these from patients from centres from the UK and Sweden. From the Guildford Colorectal Database or local databases, 258 patients who underwent SCRT and CXB with the intent of OP from five centres treated between 2007 and 2019 were identified. Response and survival data was analysed and presented. With a median age of 81, 226 patients were treated with radiotherapy alone (RTA) and 32 immediately after local excision (ILE). Median follow-up was 24 months. 70% and 97% of patients in the RTA and ILE groups respectively had a complete clinical response (cCR) after SCRT with CXB. Of those, local relapse was seen in 16% of the RTA and 3% of the ILE group. Median survival was 40 months after CXB in the RTA and 52 months in the ILE group. 94% of patients remained stoma-free to the point of latest follow-up. This data suggests that CXB when combined with SCRT, in a mainly elderly and comorbid population, provides good palliation with stoma-avoidance. Oncological outcomes compare with previously published work. A greater focus is required on quality of life outcomes after OP.
Sections du résumé
Background and purpose
UNASSIGNED
The use of external beam radiotherapy (EBRT) and contact X-Ray brachytherapy (CXB) is emerging as an effective alternative in patients with early stage rectal cancer with the intent of organ preservation (OP). Short course radiotherapy (SCRT) is an alternative EBRT schedule for patients not fit for chemotherapy or for longer courses of EBRT. There are no multicentre studies that have reported on the outcomes of SCRT with a CXB boost, therefore we present these from patients from centres from the UK and Sweden.
Materials and methods
UNASSIGNED
From the Guildford Colorectal Database or local databases, 258 patients who underwent SCRT and CXB with the intent of OP from five centres treated between 2007 and 2019 were identified. Response and survival data was analysed and presented.
Results
UNASSIGNED
With a median age of 81, 226 patients were treated with radiotherapy alone (RTA) and 32 immediately after local excision (ILE). Median follow-up was 24 months. 70% and 97% of patients in the RTA and ILE groups respectively had a complete clinical response (cCR) after SCRT with CXB. Of those, local relapse was seen in 16% of the RTA and 3% of the ILE group. Median survival was 40 months after CXB in the RTA and 52 months in the ILE group. 94% of patients remained stoma-free to the point of latest follow-up.
Conclusion
UNASSIGNED
This data suggests that CXB when combined with SCRT, in a mainly elderly and comorbid population, provides good palliation with stoma-avoidance. Oncological outcomes compare with previously published work. A greater focus is required on quality of life outcomes after OP.
Identifiants
pubmed: 36686563
doi: 10.1016/j.ctro.2023.100580
pii: S2405-6308(23)00005-8
pmc: PMC9852541
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100580Informations de copyright
© 2023 The Authors.
Déclaration de conflit d'intérêts
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Références
Clin Transl Radiat Oncol. 2021 Dec 11;33:15-22
pubmed: 35243017
Int J Radiat Oncol Biol Phys. 2018 Mar 15;100(4):926-944
pubmed: 29485072
Cancers (Basel). 2021 Dec 16;13(24):
pubmed: 34944953
Colorectal Dis. 2019 Jun;21(6):663-670
pubmed: 30742736
Lancet Gastroenterol Hepatol. 2020 May;5(5):465-474
pubmed: 32043980
Lancet Oncol. 2012 Dec;13(12):e525-36
pubmed: 23182193
Int J Radiat Oncol Biol Phys. 2018 Mar 1;100(3):565-573
pubmed: 29229327
Radiother Oncol. 2021 Sep;162:195-201
pubmed: 34329654
Ann Surg. 2018 Dec;268(6):955-967
pubmed: 29746338
BJS Open. 2021 Sep 6;5(5):
pubmed: 34686879
Colorectal Dis. 2011 Jul;13(7):779-85
pubmed: 20412094
J Clin Oncol. 2012 Nov 1;30(31):3827-33
pubmed: 23008301
Dis Colon Rectum. 2015 Feb;58(2):159-71
pubmed: 25585073
Eur J Cancer. 2017 Feb;72:124-136
pubmed: 28027515
Acta Oncol. 2015 Apr;54(4):545-51
pubmed: 25389568
Lancet Oncol. 2016 Feb;17(2):174-183
pubmed: 26705854
Br J Radiol. 2017 Dec;90(1080):20170175
pubmed: 28937269
J Clin Oncol. 2011 Dec 10;29(35):4633-40
pubmed: 22067400
Ann Oncol. 2019 Aug 1;30(8):1298-1303
pubmed: 31192355
Lancet Oncol. 2011 Jun;12(6):575-82
pubmed: 21596621
Int J Radiat Oncol Biol Phys. 2012 Jun 1;83(2):e165-71
pubmed: 22579379
Lancet Oncol. 2015 Aug;16(8):919-27
pubmed: 26156652
Clin Oncol (R Coll Radiol). 2017 Mar;29(3):198-204
pubmed: 27726909