Anne Claire Frin1, Ludovic Evesque2, Jocelyn Gal3, Karène Benezery4, Eric François1, Jean Gugenheim5, Emmanuel Benizri5, Yan Château3, Serge Marcié4, Jérome Doyen4, Jean-Pierre Gérard6. 1. CHU Nice, Department of Gastroenterology, Nice Sophia-Antipolis University, France. 2. Centre Antoine Lacassagne, Department of Medical Oncology, Nice Sophia-Antipolis University, France. 3. Centre Antoine Lacassagne, Department of Research and Methodology, Nice Sophia-Antipolis University, France. 4. Centre Antoine Lacassagne, Department of Radiation Oncology, Nice Sophia-Antipolis University, France. 5. CHU Nice, Department of Surgery, Nice Sophia-Antipolis University, France. 6. Centre Antoine Lacassagne, Department of Radiation Oncology, Nice Sophia-Antipolis University, France. Electronic address: jean-pierre.gerard@nice.unicancer.fr.
Abstract
BACKGROUND: Contact X-ray brachytherapy (CXB) has been used at Centre Antoine Lacassagne since 2002 to increase the chance of conservative treatment (organ or sphincter preservation) in rectal cancer. A consecutive series of 112 patients (pts) is reported. METHODS: Three protocols were used in selected rectal adenocarcinomas. Group 1: T1 N0 treated with local excision (LE) followed by adjuvant CXB. Group 2: T2 or 'early' T3 N0 treated with CXB combined with chemoradiotherapy (CRT) followed by surveillance or LE. Group 3: distal 'locally advanced' T3 N0-2 treated with CXB and CRT before total proctectomy. RESULTS: Group 1: 27 pt (pTis: 3; pT1: 21; pT2: 3). After LE with CXB alone (20 pt) or CXB + CRT (7 pt) one local recurrence occurred. Organ preservation was achieved in 26 pt (96%). Group 2: 45 pt (T1: 2; T2: 23; T3: 20) treated with CXB alone (4 pt) or CXB + CRT or external beam radiotherapy (EBRT) (41 pt). A clinical complete response (cCR) was observed in 43/45 (96%) and 3 pt developed a local recurrence (11% at 5 years). The specific survival was 76% at 5 years and the rate of organ preservation was 89% (40/45 pt) with good bowel function in 36 pt. Group 3: 40 pt, anterior resection (with sphincter preservation) was possible in 35 pt (86%) with a 3-year local recurrence of 6%. CONCLUSION: CXB usually combined as a boost with CRT or EBRT may safely increase the chance of a conservative treatment (organ or sphincter preservation) for selected rectal cancers.
BACKGROUND: Contact X-ray brachytherapy (CXB) has been used at Centre Antoine Lacassagne since 2002 to increase the chance of conservative treatment (organ or sphincter preservation) in rectal cancer. A consecutive series of 112 patients (pts) is reported. METHODS: Three protocols were used in selected rectal adenocarcinomas. Group 1: T1 N0 treated with local excision (LE) followed by adjuvant CXB. Group 2: T2 or 'early' T3 N0 treated with CXB combined with chemoradiotherapy (CRT) followed by surveillance or LE. Group 3: distal 'locally advanced' T3 N0-2 treated with CXB and CRT before total proctectomy. RESULTS: Group 1: 27 pt (pTis: 3; pT1: 21; pT2: 3). After LE with CXB alone (20 pt) or CXB + CRT (7 pt) one local recurrence occurred. Organ preservation was achieved in 26 pt (96%). Group 2: 45 pt (T1: 2; T2: 23; T3: 20) treated with CXB alone (4 pt) or CXB + CRT or external beam radiotherapy (EBRT) (41 pt). A clinical complete response (cCR) was observed in 43/45 (96%) and 3 pt developed a local recurrence (11% at 5 years). The specific survival was 76% at 5 years and the rate of organ preservation was 89% (40/45 pt) with good bowel function in 36 pt. Group 3: 40 pt, anterior resection (with sphincter preservation) was possible in 35 pt (86%) with a 3-year local recurrence of 6%. CONCLUSION:CXB usually combined as a boost with CRT or EBRT may safely increase the chance of a conservative treatment (organ or sphincter preservation) for selected rectal cancers.
Authors: Arthur Sun Myint; Fraser McLean Smith; Simon William Gollins; Helen Wong; Christopher Rao; Karen Whitmarsh; Raj Sripadam; Paul Rooney; Michael Jeremy Hershman; Zsolt Fekete; Kate Perkins; D Mark Pritchard Journal: Br J Radiol Date: 2017-11-10 Impact factor: 3.039
Authors: Alexandra J Stewart; Evert J Van Limbergen; Jean-Pierre Gerard; Ane L Appelt; Frank Verhaegen; Maaike Berbee; Te Vuong; Ciarna Brooker; Tim Rockall; Arthur Sun Myint Journal: Clin Transl Radiat Oncol Date: 2021-12-11