A cohort study of local excision followed by adjuvant therapy incorporating a contact x- ray brachytherapy boost instead of radical resection in 180 patients with rectal cancer.



Smith, FM, Pritchard, DM ORCID: 0000-0001-7971-3561, Wong, H, Whitmarsh, K, Hershman, MJ and Sun Myint, A
(2019) A cohort study of local excision followed by adjuvant therapy incorporating a contact x- ray brachytherapy boost instead of radical resection in 180 patients with rectal cancer. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[img] Text
CDI-00355-2018.R2 accepted manuscript.docx - Accepted Version

Download (211kB)

Abstract

AIM:Recent data have suggested near-equivalent oncological results when treating early rectal cancer by local excision followed by radio +/- chemotherapy rather than salvage radical surgery. The aim of this retrospective study was to assess the use of contact x-ray brachytherapy within this paradigm. METHODS:All patients had undergone local excision and were referred to our radiotherapy centre for treatment with contact x-ray brachytherapy. Postoperative (chemo) radiotherapy was also given in their local hospital in most cases. Variables assessed were local excision method, post-operative therapy received, follow-up duration, disease-free survival, salvage surgery and stoma-free survival. RESULTS:In total 180 patients with a median age of 70 (range 36-99) years were assessed. Following local excision, pT stages were pT1=131(72%), pT2=44(26%), pT3=5(2%). All patients received contact x-ray brachytherapy boosting at our centre and in addition 110 received chemoradiotherapy and 60 received radiotherapy alone. After a median follow up of 36 months (range 6-48), 169 patients (94%) remained free of local recurrence. Of the 11 patients with local recurrence (3 isolated nodal), 5 underwent salvage abdomino-perineal resection. 8 patients developed distant disease of whom 5 underwent metastasis surgery. At last included follow-up 173 (96%) patients were free of all disease and 170 (94%) were stoma free. CONCLUSIONS:Contact therapy can be offered in addition to external beam radio (+/-chemo) therapy instead of radical surgery as follow-on treatment after local excision of early rectal cancer. This combination can provide equivalent outcomes to radical surgery. The added value of contact therapy should be formally assessed in a clinical trial. This article is protected by copyright. All rights reserved.

Item Type: Article
Depositing User: Symplectic Admin
Date Deposited: 15 Feb 2019 09:42
Last Modified: 25 Feb 2020 10:38
DOI: 10.1111/codi.14584
URI: http://livrepository.liverpool.ac.uk/id/eprint/3032840