Contact X-Ray Brachytherapy in Planned Organ Preservation for Early Rectal Cancer
Posted: Monday, March 18, 2019
According to a study by Jean-Pierre Gérard, MD, of the Centre Antoine-Lacassagne, Nice, France, and colleagues, endoluminal irradiation dose escalation in patients with early stage rectal cancer may aid in rectal preservation. Due to the apparent radioresistance of rectal adenocarcinomas, clinical complete response and local recurrence rates have been historically subpar (40% and 25%, respectively). The authors sought to determine whether the addition of contact x-ray brachytherapy could safely improve outcomes, with the goal of preventing surgical resection/proctectomy. Their analysis was published in the European Journal of Cancer.
“Combining [contact x-ray brachytherapy] and [neoadjuvant chemoradiotherapy] in selected early T2–T3 rectal cancers may safely provide a high rate of [clinical complete response], 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,” the authors concluded.
In this retrospective analysis of data from 3 French institutions, 74 patients with T2 or T3 tumors were prospectively selected for treatment. The addition of contact x-ray brachytherapy led to clinical complete or near-complete responses in 95% of patients. After a median follow-up of 3 years, the local recurrence rate was 10%. Proctectomy was successfully avoided in 96% of patients, and bowel function was reported as good or excellent in 85% of patients. The most common side effect reported was rectal bleeding, occurring after 1 year in about one-third of the patients (12% experienced grade 3 bleeding).
Other phase III trials to assess the relevance of contact x-ray brachytherapy, and other treatment modalities to address organ preservation, are ongoing.
Disclosure: The study authors’ disclosure information may be found at ejcancer.com.