Jean-Pierre Gérard1, Nicolas Barbet2, Jocelyn Gal3, Catherine Dejean4, Ludovic Evesque5, Jérôme Doyen4, Régis Coquard6, Jean Gugenheim7, Emmanuel Benizri7, Renaud Schiappa3, Guillaume Baudin8, Karène Benezery4, Eric François5. 1. Department of Radiation Oncology, Centre Antoine-LACASSAGNE Nice University, Nice, Sophia, France. Electronic address: jean-pierre.gerard@nice.unicancer.fr. 2. Department of Radiation Oncology, Bayard Lyon, Lyon-Villeurbanne, France; Department of Radiation Oncology, Mâcon, France. 3. Department of Clinical Research-Statistics, Centre Antoine LACASSAGNE Nice University, Nice, Sophia, France. 4. Department of Radiation Oncology, Centre Antoine-LACASSAGNE Nice University, Nice, Sophia, France. 5. Department of Medical Oncology and Gastro-Intestinal Cancer, Centre Antoine LACASSAGNE Nice University, Nice, Sophia, France. 6. Department of Radiation Oncology, Bayard Lyon, Lyon-Villeurbanne, France. 7. Department of Surgery, CHU Nice, Nice University, Nice, Sophia, France. 8. Department of Radiology Diagnosis, Centre Antoine LACASSAGNE, Nice University, Nice, Sophia, France.
Abstract
BACKGROUND: Neoadjuvant chemoradiotherapy (nCRT) and watch-and-wait policy as reported by Habr-Gama are references for organ preservation in rectal cancer. To increase the clinical complete response (cCR) and reduce the local recurrence rates, we report a retrospective analysis of a prospective cohort of selected T2-3 tumours treated in three French institutions using contact X-ray brachytherapy (CXB) with nCRT. METHODS: Tumour selection was based on digital rectal examination (DRE), rigid rectoscopy, magnetic resonance imaging (MRI) and/or endorectal ultrasound. Adenocarcinoma T2-3 < 5 cm largest diameter, M0 were treated, all with organ preservation intent. CXB delivering 90 Gy/3 fractions/4 weeks was combined with CRT (capecitabine 50). Strict evaluation of tumour response using DRE and rectoscopy ± MRI was performed at regular interval with prolonged surveillance. FINDINGS: Between 2002 and 2016, 74 consecutive patients were treated (median age: 74 years. T2: 45 and T3: 29). A cCR or near-cCR (mainly rectal wall ulceration) was noted at week 14 in 71 patients (95%). A local excision was performed in 13 patients. Of three partial responses (PRs), one salvage anterior resection was performed. With a median follow-up of 3 years, local recurrence (mainly in the rectal wall) was seen in seven patients. The 3-year local recurrence rate was 10%, and the cancer-specific survival, 88%. Two patients underwent radical proctectomy for PR or local recurrence and 96% preserved their rectum. Grade III acute toxicity was recorded in five patients. Rectal bleeding was the main late toxicity (grade III in 12%). Bowel function was scored as good or excellent in 85% of patients. INTERPRETATION: Combining CXB and nCRT in selected early T2-T3 rectal cancers may safely provide a high rate of cCR, organ preservation, and good bowel function with a risk of local recurrence below 15%. Such an approach could be offered to operable patients as a planned option for organ preservation.
BACKGROUND: Neoadjuvant chemoradiotherapy (nCRT) and watch-and-wait policy as reported by Habr-Gama are references for organ preservation in rectal cancer. To increase the clinical complete response (cCR) and reduce the local recurrence rates, we report a retrospective analysis of a prospective cohort of selected T2-3 tumours treated in three French institutions using contact X-ray brachytherapy (CXB) with nCRT. METHODS:Tumour selection was based on digital rectal examination (DRE), rigid rectoscopy, magnetic resonance imaging (MRI) and/or endorectal ultrasound. Adenocarcinoma T2-3 < 5 cm largest diameter, M0 were treated, all with organ preservation intent. CXB delivering 90 Gy/3 fractions/4 weeks was combined with CRT (capecitabine 50). Strict evaluation of tumour response using DRE and rectoscopy ± MRI was performed at regular interval with prolonged surveillance. FINDINGS: Between 2002 and 2016, 74 consecutive patients were treated (median age: 74 years. T2: 45 and T3: 29). A cCR or near-cCR (mainly rectal wall ulceration) was noted at week 14 in 71 patients (95%). A local excision was performed in 13 patients. Of three partial responses (PRs), one salvage anterior resection was performed. With a median follow-up of 3 years, local recurrence (mainly in the rectal wall) was seen in seven patients. The 3-year local recurrence rate was 10%, and the cancer-specific survival, 88%. Two patients underwent radical proctectomy for PR or local recurrence and 96% preserved their rectum. Grade III acute toxicity was recorded in five patients. Rectal bleeding was the main late toxicity (grade III in 12%). Bowel function was scored as good or excellent in 85% of patients. INTERPRETATION: Combining CXB and nCRT in selected early T2-T3 rectal cancers may safely provide a high rate of cCR, organ preservation, and good bowel function with a risk of local recurrence below 15%. Such an approach could be offered to operable patients as a planned option for organ preservation.
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
Authors: Emmanouil Fokas; Ane Appelt; Alexandra Gilbert; David Sebag-Montefiore; Claus Rödel; Robert Glynne-Jones; Geerard Beets; Rodrigo Perez; Julio Garcia-Aguilar; Eric Rullier; J Joshua Smith; Corrie Marijnen; Femke P Peters; Maxine van der Valk; Regina Beets-Tan; Arthur S Myint; Jean-Pierre Gerard; Simon P Bach; Michael Ghadimi; Ralf D Hofheinz; Krzysztof Bujko; Cihan Gani; Karin Haustermans; Bruce D Minsky; Ethan Ludmir; Nicholas P West; Maria A Gambacorta; Vincenzo Valentini; Marc Buyse; Andrew G Renehan Journal: Nat Rev Clin Oncol Date: 2021-08-04 Impact factor: 66.675
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
Authors: Petra A Custers; Barbara M Geubels; Inge L Huibregtse; Femke P Peters; Ellen G Engelhardt; Geerard L Beets; Corrie A M Marijnen; Monique E van Leerdam; Baukelien van Triest Journal: Cancers (Basel) Date: 2021-12-16 Impact factor: 6.639