Arthur Sun Myint1, Fraser McLean Smith2, Simon Gollins3, Helen Wong4, Christopher Rao5, Karen Whitmarsh4, Raj Sripadam4, Paul Rooney2, Michael Hershman6, D Mark Pritchard7. 1. The Clatterbridge Cancer Centre, Liverpool, United Kingdom; Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom. Electronic address: sun.myint@nhs.net. 2. The Royal Liverpool and Broadgreen University Hospital National Health Service Trust, Liverpool, United Kingdom. 3. North Wales Cancer Treatment Centre, Rhyl, United Kingdom. 4. The Clatterbridge Cancer Centre, Liverpool, United Kingdom. 5. Department of Surgery, University Hospital Lewisham, London, United Kingdom. 6. New Cross Hospital, Wolverhampton, United Kingdom. 7. Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; The Royal Liverpool and Broadgreen University Hospital National Health Service Trust, Liverpool, United Kingdom.
Abstract
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.
PURPOSE: To review the outcomes of rectal cancerpatients 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 cancerpatients 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.
Authors: Stijn H J Ketelaers; Anne Jacobs; An-Sofie E Verrijssen; Jeltsje S Cnossen; Irene E G van Hellemond; Geert-Jan M Creemers; Ramon-Michel Schreuder; Harm J Scholten; Jip L Tolenaar; Johanne G Bloemen; Harm J T Rutten; Jacobus W A Burger Journal: Cancers (Basel) Date: 2022-05-11 Impact factor: 6.575
Authors: Fernando López-Campos; Margarita Martín-Martín; Roberto Fornell-Pérez; Juan Carlos García-Pérez; Javier Die-Trill; Raquel Fuentes-Mateos; Sergio López-Durán; José Domínguez-Rullán; Reyes Ferreiro; Alejandro Riquelme-Oliveira; Asunción Hervás-Morón; Felipe Couñago Journal: World J Gastroenterol Date: 2020-08-07 Impact factor: 5.742