Dose Escalation Using Contact X-ray Brachytherapy After External Beam Radiotherapy as Nonsurgical Treatment Option for Rectal Cancer: Outcomes From a Single-Center Experience
| Autor: | Michael J Hershman, Simon Gollins, Paul Rooney, F. M. Smith, Arthur Sun Myint, D. Mark Pritchard, Raj Sripadam, Karen Whitmarsh, Helen Wong, Christopher Rao |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Cancer Research
medicine.medical_specialty Radiation Colorectal cancer business.industry medicine.medical_treatment Brachytherapy 030230 surgery medicine.disease Single Center Nonsurgical treatment Surgery Radiation therapy 03 medical and health sciences 0302 clinical medicine Oncology 030220 oncology & carcinogenesis medicine Radiology Nuclear Medicine and imaging External beam radiotherapy Radical surgery business Chemoradiotherapy |
| Zdroj: | International Journal of Radiation: Oncology-Biology-Physics |
| Popis: | Purpose To review the outcomes of rectal cancer patients treated with a nonsurgical approach using contact x-ray brachytherapy (CXB) when suspicious residual disease (≤3 cm) was present after external beam chemoradiation therapy/radiation therapy (EBCRT/EBRT). Methods and Materials Outcome data for rectal cancer patients referred to our institution from 2003 to 2012 were retrieved from an institutional database. These patients were referred after initial local multidisciplinary team discussion because they were not suitable for, or had refused, surgery. All selected patients received a CXB boost after EBCRT/EBRT. Most patients received a total of 90 Gy of CXB delivered in 3 fractions over 4 weeks. Results The median follow-up period was 2.5 years (range 1.2-8.3). Of 345 consecutive patients with rectal cancer referred to us, 83 with suspicious residual disease (≤3 cm) after EBCRT/EBRT were identified for a CXB boost. Their median age was 72 years (range 36-87), and 58 (69.9%) were men. The initial tumor stages were cT2 (n = 28) and cT3 (n = 55), and 54.2% were node positive. A clinical complete response (cCR) was achieved in 53 patients (63.8%) after the CXB boost that followed EBCRT/EBRT. Of these 53 patients, 7 (13.2%) developed a relapse after achieving a cCR, and the 6 patients (11.6%) with nonmetastatic regrowth underwent salvage surgery (100%). At the end of the study period, 69 of 83 patients (83.1%) were cancer free. Conclusions Our data suggest that a CXB boost for selected patients with suspicious residual disease (≤3 cm) after EBCRT/EBRT can be offered as an alternative to radical surgery. In our series, patients with a sustained cCR had a low rate of local regrowth, and those with nonmetastatic regrowth could be salvaged successfully. This approach could provide an alternative treatment option for elderly or comorbid patients who are not suitable for surgery and those with rectal cancer who wish to avoid surgery. |
| Databáze: | OpenAIRE |
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