Dose escalation using contact x-ray brachytherapy (Papillon) for rectal cancer. Does it improve the chance of organ preservation?

Autor: Zsolt Fekete, Michael J Hershman, K. Perkins, Arthur Sun Myint, Karen Whitmarsh, Simon Gollins, Helen Wong, D. Mark Pritchard, Raj Sripadam, F. M. Smith, Christopher Rao, Paul S. Rooney
Rok vydání: 2017
Předmět:
Adult
Male
medicine.medical_specialty
Colorectal cancer
medicine.medical_treatment
Brachytherapy
Kaplan-Meier Estimate
030230 surgery
Disease-Free Survival
Endosonography
03 medical and health sciences
0302 clinical medicine
Endorectal ultrasound
Median follow-up
medicine
Dose escalation
Humans
Radiology
Nuclear Medicine and imaging
Aged
Retrospective Studies
Aged
80 and over
medicine.diagnostic_test
Full Paper
business.industry
Rectal Neoplasms
Magnetic resonance imaging
Retrospective cohort study
Dose-Response Relationship
Radiation
General Medicine
Middle Aged
medicine.disease
Magnetic Resonance Imaging
Surgery
Treatment Outcome
030220 oncology & carcinogenesis
Critical Pathways
Female
Neoplasm Recurrence
Local
business
Tomography
X-Ray Computed
Organ Sparing Treatments
Chemoradiotherapy
Zdroj: BRITISH JOURNAL OF RADIOLOGY
Popis: Objective: A watch and wait policy for patients with a clinical complete response (cCR) after external beam chemoradiotherapy (EBCRT) for rectal cancer is an attractive option. However, approximately one-third of tumours will regrow, which requires surgical salvage for cure. We assessed whether contact X-ray brachytherapy (CXB) can improve organ preservation by avoiding surgery for local regrowth. Methods: From our institutional database, we identified 200 of 573 patients treated by CXB from 2003 to 2012. Median age was 74 years (range 32–94), and 134 (67%) patients were males. Histology was confirmed in all patients and was staged using CT scan, MRI or endorectal ultrasound. All patients received combined CXB and EBCRT, except 17 (8.5%) who had CXB alone. Results: Initial cCR was achieved in 144/200 (72%) patients. 38/56 (68%) patients who had residual tumour received immediate salvage surgery. 16/144 (11%) patients developed local relapse after cCR, and 124/144 (86%) maintained cCR. At median follow up of 2.7 years, 161 (80.5%) patients were free of cancer. The main late toxicity was bleeding (28%). Organ preservation was achieved in 124/200 (62%) patients. Conclusion: Our data suggest that CXB can reduce local regrowth to 11% compared with around 30% after EBCRT alone. Organ preservation of 62% achieved was higher than reported in most published watch and wait studies. Advances in knowledge: CXB is a promising treatment option to avoid salvage surgery for local regrowth, which can improve the chance of organ preservation in patients who are not suitable for or refuse surgery.
Databáze: OpenAIRE
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