Long-Term Patient-Reported Outcomes After High-Dose Chemoradiation Therapy for Nonsurgical Management of Distal Rectal Cancer

Dizdarevic, Edina; Hansen, Torben Frøstrup; Pløen, John; Jensen, Lars Henrik; Lindebjerg, Jan; Rafaelsen, Søren Rafael; Jakobsen, Anders; Appelt, Ane L

doi:10.1016/j.ijrobp.2019.10.046

Cited by 37 publications

(28 citation statements)

References 19 publications

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“…10,15,24 This exploratory analysis supports favourable longer-term patient-reported outcome scores seen at 1-year, 2-year, and 5-year follow-ups after organ preservation in various trials. 10,33 Our data provide an important contribution to the literature due to the absence of published randomised studies comparing patient-reported outcomes following total mesorectal excision and organ preservation. Although an unexpected finding, the lower baseline mean scores in a number of function items for the radical surgery group (completed after knowledge of randomisation status) might reflect our impression that the perceived risks of surgery in early-stage rectal cancer are higher than patients desire.…”

Section: Discussionmentioning

confidence: 96%

Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study

Bach¹,

Gilbert²,

Brock³

et al. 2021

The Lancet Gastroenterology & Hepatology

119

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Background Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision.Methods TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8-10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743.

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Section: Discussionmentioning

confidence: 96%

Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study

Bach¹,

Gilbert²,

Brock³

et al. 2021

The Lancet Gastroenterology & Hepatology

119

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“…Whether this represents a relevant parameter in the context of organ preservation in rectal cancer needs to be addressed in future investigations. Interestingly, rectal bleeding was one of the dominant late toxicities in a prospective study on dose escalated radiotherapy using a brachytherapy boost to a total dose of 65 Gy [36]. Regarding anal sphincter function, in a retrospective study of patients with LARC [37] a series of dosimetric parameters was correlated with loss of sphincter function.…”

Section: Discussionmentioning

confidence: 99%

1.5 T MR-linac planning study to compare two different strategies of rectal boost irradiation

Bonomo

Russo

Nachbar³

et al. 2021

Clinical and Translational Radiation Oncology

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“…Brachytherapy does not form part of the standard multimodal approach to rectal or anal cancer. However, organ preservation approaches to lower GI tumours have explored dose escalation with brachytherapy as an alternative to surgical management with encouraging results [38,39]. The main indication for brachytherapy in the elderly population with ano-rectal tumours is in those who are unfit for standard care with palliative options being offered for inoperable, locally advanced and recurrent disease.…”

Section: Rectal Cancermentioning

confidence: 99%

Practical brachytherapy solutions to an age-old quandary

Thiruthaneeswaran

Tharmalingam

Hoskin

2020

Technical Innovations & Patient Support in Radiation Oncolo

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Cancer is predominantly a disease of the elderly and as population life expectancy increases, so will the incidence of malignant disease. Elderly patients often have other comorbidities and social complexities, increasing the support required to safely deliver all treatment modalities. Brachytherapy is a relatively simple technique by which radiation therapy can be delivered. It offers dosimetric advantages through a highly conformal dose distribution thereby limiting radiation exposure to normal tissues reducing toxicity. Requiring fewer hospital visits, it also offers practical and logistical advantages to the elderly population and in many cases can be performed without the need for general anaesthesia. In tumour streams where brachytherapy forms part of the curative management, it should not be omitted in elderly patients who are medically fit for treatment. In the palliative setting, brachytherapy often offers an excellent means for achieving either local tumour and/or symptom control and should be actively considered in the therapeutic armamentarium of the oncologist in this context.

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Long-Term Patient-Reported Outcomes After High-Dose Chemoradiation Therapy for Nonsurgical Management of Distal Rectal Cancer

Cited by 37 publications

References 19 publications

Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study

Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study

1.5 T MR-linac planning study to compare two different strategies of rectal boost irradiation

Practical brachytherapy solutions to an age-old quandary

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