Dose Escalation Using Contact X-ray Brachytherapy After External Beam Radiotherapy as Nonsurgical Treatment Option for Rectal Cancer: Outcomes From a Single-Center Experience

Myint, Arthur Sun; Smith, F. H.; Gollins, Simon; Wong, Helen; Rao, Christopher; Whitmarsh, Karen; Sripadam, Raj; Rooney, Paul; Hershman, M. J.; Pritchard, D. Mark

doi:10.1016/j.ijrobp.2017.10.022

Cited by 69 publications

(65 citation statements)

References 29 publications

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“…The data we present highlight the oncological safety of nonoperative management of such patients who have received a CXB boost in combination with EBRT AE chemotherapy within our institution. Importantly, our data show equivalent local control to radical completion surgery as reported by a recent systematic review on the subject and better than average results than with chemoradiotherapy alone [13]. These data suggest that all patients should be made aware of the alternative treatment options for early rectal cancer at the time of informed consent and their views should be taken into account when final treatment decisions are made.…”

Section: Resultssupporting

confidence: 79%

“…CXB has been the standard of care in our unit for over 20 years and so it was not delivered as part of a trial. We believe, however, that an advantage of our data is that we report 'real-world' outcomes from a large and unique study group, which in turn can be broadly compared with the numerous reports of management without CXB [13]. Notwithstanding this, however, we do accept that definitive proof of the benefits of CXB in addition to postoperative EBRT AE chemotherapy would be best assessed in a prospective, randomized setting.…”

Section: Discussionmentioning

confidence: 87%

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A cohort study of local excision followed by adjuvant therapy incorporating a contact X‐ray brachytherapy boost instead of radical resection in 180 patients with rectal cancer

et al. 2019

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Aim Recent data have suggested near‐equivalent oncological results when treating early rectal cancer by local excision followed by radio‐ ± chemotherapy rather than salvage radical surgery. The aim of this retrospective study was to assess the use of contact X‐ray brachytherapy within this paradigm. Method All patients had undergone local excision and were referred to our radiotherapy centre for treatment with contact X‐ray brachytherapy. Postoperative (chemo)radiotherapy was also given in their local hospital in most cases. Variables assessed were local excision method, postoperative therapy received, follow‐up duration, disease‐free survival, salvage surgery and stoma‐free survival. Results In total, 180 patients with a median age of 70 (range 36–99) years were assessed. Following local excision, pT stages were pT1 = 131 (72%), pT2 = 44 (26%), pT3 = 5 (2%). All patients received contact X‐ray brachytherapy boosting at our centre and, in addition, 110 received chemoradiotherapy and 60 received radiotherapy alone. After a median follow‐up of 36 months (range 6–48), 169 patients (94%) remained free of local recurrence. Of the 11 patients with local recurrence (three isolated nodal), five underwent salvage abdominoperineal excision. Eight patients developed distant disease, of whom five underwent metastasis surgery. At last included follow‐up 173 (96%) patients were free of all disease and 170 (94%) were stoma free. Conclusions Contact therapy can be offered in addition to external beam radio (±chemo) therapy instead of radical surgery as follow‐on treatment after local excision of early rectal cancer. This combination can provide equivalent outcomes to radical surgery. The added value of contact therapy should be formally assessed in a clinical trial.

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Section: Resultssupporting

confidence: 79%

Section: Discussionmentioning

confidence: 87%

A cohort study of local excision followed by adjuvant therapy incorporating a contact X‐ray brachytherapy boost instead of radical resection in 180 patients with rectal cancer

et al. 2019

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“…In most cohorts, radiation doses of 45-50.4 Gy were used. Higher doses were utilized in some cohorts, often with brachytherapy boost or Papillion contact X-ray boost [19,20,23,24]. LR and DM were recorded when they occurred at any time in 12 series.…”

Section: Resultsmentioning

confidence: 99%

The risk of distant metastases in rectal cancer managed by a watch-and-wait strategy – A systematic review and meta-analysis

Socha

Kępka

Michalski

et al. 2020

Radiotherapy and Oncology

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Background: The watch-and-wait (w&w) strategy is associated with frequent local regrowth (LR). Distant metastases (DM) occur more often in the patients with LR than in those without. However, it is unknown whether omitting immediate surgery results in the additional risk of DM. Materials/methods: A systematic review and meta-analysis were performed to determine the maximum risk of additional DM. To estimate this, we used data showing the proportions of DM in patients with and without LR, assuming that the excess DM in patients with LR may develop in two ways: from subclinical DM already present at baseline and due to seeding from the uncontrolled primary tumor, and that the incidence of subclinical DM at baseline in the LR subgroup is at least not lower than in the non-LR subgroup. Based on the calculated rate of excess DM in the LR subgroup we have obtained the rate for the whole group of patients undergoing w&w. Results: The maximum estimated risk of additional DM was 3.0% (95% CI: 1.2-4.9%) in the total group. After correction for short follow-up, the maximum risk at 5 years was 6.5%. Thus, the risk of excess DM is between 0% and 6.5%. Other evidence from a systematic review and the conservative assumptions taken for the calculation of the correction suggest that this maximum risk may be overestimated. Conclusions: The additional risk of DM seems to be low. However, the high probability of bias, heterogeneity of the patients' population and low quality of evidence make our estimation uncertain.

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“…The endpoint was the oncological outcome after a three-year interval (21). Data on this topic indicates that there is no difference in survival untill regrowth between w&w patients with a complete clinical response and patients who undergo surgery after a 2-year follow-up interval (22,23).…”

Section: Discussionmentioning

confidence: 99%

Watch and Wait Strategy for Rectal Cancer: 15 Years After the First Published Study. Are We any Closer to the Non-operative Management of Rectal Cancer?

Tulin¹,

Nițipir²,

Slavu³

et al. 2019

chr

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Introducere: De-a lungul timpului, tratamentul cancerului rectal a evoluat semnificativ prin utilizarea sporită a radiochimoterapiei neoadjuvante. Material şi metoda: Ghidul P.I.C.O.S a fost utilizat pentru a structura întrebările şi topica cercetării în vederea obţinerii validităţii clinice. Rezultatele obţinute au fost filtrate conform ghidului PRISMA. Rezultate: Am identificat un număr de 42 de lucrări, după screeningul acestora, au rămas 27 pentru a completa cercetarea. Discuţii: Există un interes crescut faţă de managementul neoperator al cancerului rectal întrucât până la 25% dintre pacienţii supuşi unui regim de radiochimioterapie preoperatorie au demonstrat răspuns patologic complet (absenţa celulelor tumorale pe specimenele rezecate). Aceste informaţii conduc la ideea atrăgătoare că, în unele cazuri, intervenţia chirurgicală poate fi evitată. Din nefericire, există o lipsă de date de calitate pentru a susţine această nouă tendinţă. Datorită interesului recent crescut a fost creată o bază de date internaţională în care pacienţii aflaţi în perioada de w&w pot fi înscrişi şi monitorizaţi. Până în prezent, baza de date conţine peste 900 de pacienţi. De asemenea, sunt în curs de finalizare studii prospective de calitate. Concluzii: Cu toate aceste eforturi recente, utilizarea pe scară largă Abstract Introduction: Over time, the management of rectal cancer has undoubtedly evolved with the use of neoadjuvant radiochemotherapy. Material and method: The P.I.C.O.S guidelines were used to structure the questions and the research topic as to attain clinical validity. The results of the research were filtered in accordance with the PRISMA checklist. Results: We identified 42 papers. After screening 27 papers were used to complete the analysis. Discussion: There is an increased interest towards the non-operative management of rectal cancer, as up to 25% of patients with preoperative radiochemotherapy have demonstrated complete pathological response (absence of tumor cells on the operative specimens). This information leads to the tantalizing idea that in some cases, surgery can be avoided. Unfortunately, there is a lack of quality data to support this view. Due to increased interest in this subject, an international database in which patients with w&w therapy can be enrolled and monitored. Up to now, the database contains over 900 patients. Also, quality prospective trials are emerging. Conclusion: Even with all these recent efforts, the wide-use of this therapy is precluded due to the absence of a standardized evaluation of these patients in the follow-up period.

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Dose Escalation Using Contact X-ray Brachytherapy After External Beam Radiotherapy as Nonsurgical Treatment Option for Rectal Cancer: Outcomes From a Single-Center Experience

Cited by 69 publications

References 29 publications

A cohort study of local excision followed by adjuvant therapy incorporating a contact X‐ray brachytherapy boost instead of radical resection in 180 patients with rectal cancer

A cohort study of local excision followed by adjuvant therapy incorporating a contact X‐ray brachytherapy boost instead of radical resection in 180 patients with rectal cancer

The risk of distant metastases in rectal cancer managed by a watch-and-wait strategy – A systematic review and meta-analysis

Watch and Wait Strategy for Rectal Cancer: 15 Years After the First Published Study. Are We any Closer to the Non-operative Management of Rectal Cancer?

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