Contact X-Ray Brachytherapy for Early Rectal Cancer: A Review of Outcomes From a Single UK Centre |
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| Affiliation: | 1. St Luke''s Cancer Centre, Royal Surrey County Hospital, Guildford, UK;2. University of Surrey, Guildford, UK;3. Loyola University Chicago Stritch School of Medicine, Chicago, Illinois, USA;4. Clinical Haematology and Oncology Centre, Queen Alexandra Hospital, Portsmouth, UK;1. Department of Hematology, The First People''s Hospital of Yunnan Province, Yunnan, China;2. The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China;1. Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, PR China;2. Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China;3. Department of Gynecologic Oncology, Women''s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China;4. Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, PR China;5. Gynecology Oncology Key Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, PR China;1. Royal Cornwall Hospital NHS Trust, Truro, UK;2. Department of Obstetrics & Gynecology, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, the Netherlands;3. Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands;4. Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands;5. Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, the Netherlands;7. Derriford Hospital Plymouth, Plymouth, UK;11. Grow School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands;12. Catharina Hospital, Eindhoven, the Netherlands;1. University College London Hospitals NHS Foundation Trust, London, United Kingdom;2. The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom;3. The Institute of Cancer Research, London, United Kingdom;4. Radiotherapy Trials Quality Assurance (RTTQA) Group, Northwood, United Kingdom;5. Cancer Centre, Addenbrooke''s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom |
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| Abstract: | AimsColorectal cancer is the fourth most prevalent cancer in the UK. Fortunately, with modern surveillance programmes, more patients are being diagnosed at an earlier stage. Although surgical excision remains the gold standard, many patients have co-morbidities that preclude them from having radical surgery. Additionally, a number of patients do not wish to live with a permanent colostomy. Radiotherapy has an established role in the non-surgical treatment of patients with rectal cancer. Increasing the radiation dose to the tumour increases the chance of local control. Using contact X-ray brachytherapy (CXB) it is possible to escalate the dose to the tumour and minimise the dose received by surrounding normal tissues. The aim of this study was to evaluate the outcomes of patients from our centre who have undergone CXB with or without external beam radiotherapy.Materials and methodsA prospectively maintained and locally managed colorectal database was used to collect clinical details and outcomes for colorectal cancer patients. All patients who were treated with CXB at our institution from the commencement of the service in April 2014 to the end of December 2019 were analysed. There was a minimum of 18 months of follow-up.ResultsOne hundred and ninety-three patients received at least one fraction of CXB. The median age at first treatment was 72 years (range 33–103 years). Seventy-three per cent of patients were male. Of the operable or high surgical risk patients, 105 were treated radically with radiotherapy, 28 were treated radically with radiotherapy after local resection and 22 patients were medically unfit for surgery. Most patients received external beam radiotherapy 45 Gy/25 fractions (87/146) or 25 Gy in five fractions (35/146). Forty-seven patients received CXB as sole treatment (51% had previous radiotherapy). Of those with a response assessment, with a median follow-up of 35 months, 78% of all patients achieved a clinical complete response (cCR) or a near cCR, 6% had a partial response and 16% had persistent disease. Of 154 radically treated patients with a response assessment, 84% achieved cCR or near cCR, 19% (24/129) of these subsequently relapsed.ConclusionThis series shows that CXB is a well-tolerated and effective treatment in a diverse cohort of patients with rectal cancer. Comparable favourable oncological outcomes were seen, in keeping with previously published work. |
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| Keywords: | Contact X-ray brachytherapy organ preservation papillon technique rectal cancer |
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