Long-term outcomes of patients treated with contact X-ray brachytherapy and external beam (chemo)radiotherapy following local excision of rectal adenocarcinoma

Haq, MU ORCID: 0000-0002-2303-7469, Pritchard, DM ORCID: 0000-0001-7971-3561, Hughes, DM ORCID: 0000-0002-1287-9994, Javed, MA ORCID: 0000-0003-0402-2285, Yasmin, H, Than, NW ORCID: 0000-0003-4991-5431, Duckworth, CA ORCID: 0000-0001-7971-3561, Ahmed, S, Sripadam, R ORCID: 0000-0003-4021-0611 and Myint, AS (2025) Long-term outcomes of patients treated with contact X-ray brachytherapy and external beam (chemo)radiotherapy following local excision of rectal adenocarcinoma European Journal of Surgical Oncology, 51 (9). 110216-. ISSN 0748-7983, 1532-2157

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Abstract

Introduction: Local excision can be a definitive treatment for T1 SM1 N0 rectal adenocarcinomas, but post-excision histology may reveal adverse features or more advanced tumour stage, requiring adjuvant treatment. For patients who are unfit or unwilling to undergo invasive surgery, Contact X-ray Brachytherapy (CXB) boost and external beam (chemo)radiotherapy [EB(C)RT] can be used as an alternative option to reduce recurrence risk. Methods: This study reports on patients who received post excision CXB with EB(C)RT between 2003 and 2020. It reports on lesion characteristics, excision techniques, and adjuvant treatment characteristics. Survival outcomes were compared across local excision techniques and radiotherapy schedules. Regression analysis was conducted to identify factors predictive of (local and distant) recurrence. Results: In this cohort of 323 patients 5-year overall survival (OS) was 84.2 %, 3-year recurrence free survival (RFS) was 91.6 %, with 94.7 % disease-free and 95 % stoma-free. No significant differences were observed for 5-year OS and 3-year RFS between excision types (p = 0.10, p = 0.56) or radiotherapy schedules (p = 0.90, p = 0.13) respectively. Resection margin involvement tripled recurrence risk compared to R0 resections (OR = 3.67, 95 % CI: 1.13–16.42, p = 0.048). Conclusion: For high-risk pT1 tumours, post-excision treatment with EB(C)RT and CXB boost resulted in survival outcomes comparable to those reported with conversion to radical surgery. There were no significant differences in survival outcomes between radiotherapy schedules and local excision techniques. Involved resection margins were associated with a significantly increased recurrence risk. The clinical benefit of CXB should be formally evaluated in large, prospective studies.

Item Type:	Article
Uncontrolled Keywords:	Humans, Adenocarcinoma, Rectal Neoplasms, Neoplasm Recurrence, Local, Neoplasm Staging, Disease-Free Survival, Treatment Outcome, Brachytherapy, Survival Rate, Retrospective Studies, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Proctectomy
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Population Health Faculty of Health & Life Sciences > Inst. Systems, Molec & Integrative Biology > Inst. Systems, Molec & Integrative Biology
Depositing User:	Symplectic Admin
Date Deposited:	09 Jul 2025 09:45
Last Modified:	22 Jan 2026 14:44
DOI:	10.1016/j.ejso.2025.110216
Open Access URL:	https://doi.org/10.1016/j.ejso.2025.110216
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3193645
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