Myint, Arthur Sun, Smith, Fraser McLean, Gollins, Simon William, Wong, Helen, Rao, Christopher, Whitmarsh, Karen, Sripadam, Raj, Rooney, Paul, Hershman, Michael Jeremy, Fekete, Zsolt et al (show 2 more authors)
(2017)
Dose escalation using contact X-ray brachytherapy (Papillon) for rectal cancer: does it improve the chance of organ preservation?
BRITISH JOURNAL OF RADIOLOGY, 90 (1080).
20170175-.
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Abstract
<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.
Item Type: | Article |
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Uncontrolled Keywords: | Humans, Rectal Neoplasms, Neoplasm Recurrence, Local, Tomography, X-Ray Computed, Magnetic Resonance Imaging, Endosonography, Disease-Free Survival, Treatment Outcome, Brachytherapy, Retrospective Studies, Dose-Response Relationship, Radiation, Adult, Aged, Aged, 80 and over, Middle Aged, Critical Pathways, Female, Male, Kaplan-Meier Estimate, Organ Sparing Treatments |
Depositing User: | Symplectic Admin |
Date Deposited: | 06 Oct 2017 10:57 |
Last Modified: | 08 Jan 2024 07:23 |
DOI: | 10.1259/bjr.20170175 |
Related URLs: | |
URI: | https://livrepository.liverpool.ac.uk/id/eprint/3009818 |