Clinical selection strategy for and evaluation of intra-operative brachytherapy in patients with locally advanced and recurrent rectal cancer.

Autor: Dijkstra EA; University of Groningen, University Medical Centre Groningen, Department of Medical Oncology, the Netherlands., Mul VEM; University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, the Netherlands., Hemmer PHJ; University of Groningen, University Medical Centre Groningen, Department of Surgery, the Netherlands., Havenga K; University of Groningen, University Medical Centre Groningen, Department of Surgery, the Netherlands., Hospers GAP; University of Groningen, University Medical Centre Groningen, Department of Medical Oncology, the Netherlands., Kats-Ugurlu G; University of Groningen, University Medical Centre Groningen, Department of Pathology and Medical Biology, the Netherlands., Beukema JC; University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, the Netherlands., Berveling MJ; University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, the Netherlands., El Moumni M; University of Groningen, University Medical Centre Groningen, Department of Surgery, the Netherlands., Muijs CT; University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, the Netherlands., van Etten B; University of Groningen, University Medical Centre Groningen, Department of Surgery, the Netherlands. Electronic address: b.van.etten@umcg.nl.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2021 Jun; Vol. 159, pp. 91-97. Date of Electronic Publication: 2021 Mar 17.
DOI: 10.1016/j.radonc.2021.03.010
Abstrakt: Background and Purpose: A radical resection of locally advanced rectal cancer (LARC) or recurrent rectal cancer (RRC) can be challenging. In case of increased risk of an R1 resection, intra-operative brachytherapy (IOBT) can be applied. We evaluated the clinical selection strategy for IOBT.
Materials and Methods: Between February 2007 and May 2018, 132 LARC/RRC patients who were scheduled for surgery with IOBT standby, were evaluated. By intra-operative inspection of the resection margin and MR imaging, it was determined whether a resection was presumed to be radical. Frozen sections were taken on indication. In case of a suspected R1 resection, IOBT (1 × 10 Gy) was applied. Histopathologic evaluation, treatment and toxicity data were collected from medical records.
Results: Tumour was resected in 122 patients. IOBT was given in 42 patients of whom 54.8% (n = 23) had a histopathologically proven R1 resection. Of the 76 IOBT-omitted R0 resected patients, 17.1% (n = 13) had a histopathologically proven R1 resection. In 4 IOBT-omitted patients, a clinical R1/2 resection was seen. In total, correct clinical judgement occurred in 72.6% (n = 88) of patients. In LARC, 58.3% (n = 14) of patients were overtreated (R0, with IOBT) and 10.9% (n = 5) were undertreated (R1, without IOBT). In RRC, 26.5% (n = 9) of patients were undertreated.
Conclusion: In total, correct clinical judgement occurred in 72.6% (n = 88). However, in 26.5% (n = 9) RRC patients, IOBT was unjustifiedly omitted. IOBT is accompanied by comparable and acceptable toxicity. Therefore, we recommend IOBT to all RRC patients at risk of an R1 resection as their salvage treatment.
Competing Interests: Declaration of Competing Interest 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.
(Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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