Image Guided Adaptive Endorectal Brachytherapy in the Nonoperative Management of Patients With Rectal Cancer

Aurelie Garant, Sindy Magnan, Slobodan Devic, André Guy Martin, Marylise Boutros, Carol Ann Vasilevsky, Stéphanie Ferland, Alexis Bujold, Sylvain DesGroseilliers, Herawaty Sebajang, Carole Richard, Té Vuong

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Purpose: Organ preservation or nonoperative management of rectal cancer is of growing interest. Image guided adaptive endorectal brachytherapy is a radiation dose escalation modality: we explored its role in elderly patients unfit for surgery and patients refusing surgery. Methods and Materials: In this registry study, patients with rectal cancer who were ineligible for surgery received 40 Gy in 16 fractions of pelvic external beam radiation therapy. They subsequently received 3 weekly image guided adaptive brachytherapy boosts of 10 Gy to the residual tumor, for a total of 30 Gy in 3 fractions. Complete clinical response (cCR) and local control were the primary endpoints. Results: 94 patients were included; the median age was 81.1 years. With a median follow-up of 1.9 years, the proportion of cCR was 86.2%, the tumor regrowth proportion was 13.6%, and the cumulative incidence of local relapse was 2.7% at 1 year and 16.8% at 2 years. When considering responders and nonresponders, the 2-year local control was 71.5%. The overall survival at 2 years was 63.6%. Acute rectal grade 1 to 2 toxicity included all patients: 12.8% of patients had late bleeding requiring iron replacement, blood transfusions, or argon plasma therapy. Conclusions: Results of this registry study, evaluating radiation dose escalation for elderly medically unfit patients with unselected tumors, reveal that a high proportion of patients achieved cCR with a manageable toxicity profile. This technology will likely contribute to the challenging nonoperative management paradigm of rectal cancer.

Original languageEnglish (US)
Pages (from-to)1005-1011
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume105
Issue number5
DOIs
StatePublished - Dec 1 2019
Externally publishedYes

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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    Garant, A., Magnan, S., Devic, S., Martin, A. G., Boutros, M., Vasilevsky, C. A., Ferland, S., Bujold, A., DesGroseilliers, S., Sebajang, H., Richard, C., & Vuong, T. (2019). Image Guided Adaptive Endorectal Brachytherapy in the Nonoperative Management of Patients With Rectal Cancer. International Journal of Radiation Oncology Biology Physics, 105(5), 1005-1011. https://doi.org/10.1016/j.ijrobp.2019.08.042