Toxicity outcome of endorectal brachytherapy boost in medically inoperable patients
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SHORT COMMUNICATION
Toxicity outcome of endorectal brachytherapy boost in medically inoperable patients CL Chiang1,2,3 · SF Lee1 · Venus WY Lee1 · Cynthia SY Yeung1 · Steven KT Cheung1 · Michael CM Poon4 · Dominic CC Foo5 · SH Lo5 · KO Lam2,3 · Francis AS Lee1 · Frank CS Wong1 · Mark KH Chan1,6 Received: 5 December 2019 / Accepted: 16 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Aim This communication reviews results and toxicity of image-guided high-dose-rate endorectal brachytherapy (HDREBT) boost after external beam radiotherapy (ERT) in medically inoperable patients with rectal cancer. Materials and methods A total of 18 patients with rectal cancer and clinical stage T2-4N0-2 treated with HDREBT boost after ERT were retrospectively reviewed. Results Following treatment with a median total dose (EQD2, α/β = 10) of 66 Gy (range 48–92 Gy), the incidence of early and late rectal grade 3 toxicity was 11% and 19%, respectively. There was no correlation between the occurrence of acute and late toxicity. Conclusion With proper technique, a combined approach using EBRT and HDREBT was associated with acceptable toxicity in medically inoperable rectal cancer patients.
Keywords High dose rate endorectal brachytherapy · Rectal cancer · Medically inoperable · Toxicity · Rectal brachytherapy
Introduction Total mesorectal excision with or without neo-adjuvant (chemo-)radiation is the standard of care in rectal cancer patients [1]. But, this approach is associated with substantial risks of postoperative morbidity and mortality in the elderly population [2, 3]. Palliative external beam radiotherapy (ERT) is often offered as an alternative; however, the treatment effect is disappointing [4]. CL Chiang
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Radiation dose escalation has been shown to improve local control in patients who received nonsurgical treatment [5]. High-dose-rate endorectal brachytherapy (HDREBT) is a promising technique to provide very high dose radiation to the tumor with limited radiation to nearby normal tissue [6]. There are very few publications on combining ERT and HDREBT in medically inoperable patients. In a recently published phase I trial, a promising response rate of ~90% was noted but the late grade 3+ toxicity was reported in 40% of patients [7]. More evidence is needed for the toxicity profile and radiation technique of this combined approach. This manuscript reviewed the safety profile of 18 patients who received this combined external and internal radiotherapy.
1
Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
2
Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
Patients and methods
3
Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
Patients
4
Department of Surgery, Tuen Mun Hospital, Hong Kong, China
5
Department of Surgery, Queen Mary Hospital, Hong Kong, China
6
Clinic for Radiation Oncology, University Hospital Essen, Essen, Germany
Data of patients who were treated with combined ERT and HDREBT boost
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