eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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2/2023
vol. 15
 
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abstract:
Original paper

Complication and response assessment of high-dose-rate endorectal brachytherapy boost in neo-adjuvant chemoradiotherapy of locally advanced rectal cancer with long-term outcomes

Arefeh Saeedian
1, 2
,
Marzieh Lashkari
1, 2
,
Reza Ghalehtaki
1, 2
,
Maryam Taherioun
1, 2
,
Mahdieh Razmkhah
1, 2
,
Ali Kazemian
1, 2
,
Mahdi Aghili
1, 2

  1. Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
  2. Department of Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran
J Contemp Brachytherapy 2023; 15, 2: 117–122
Online publish date: 2023/04/28
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Purpose:
To identify efficacy, complication, and pathologic response of high-dose-rate endorectal brachytherapy (HDR-BRT) boost in neo-adjuvant chemoradiotherapy (nCRT) of locally advanced rectal cancer.

Material and methods:
Forty-four patients who met eligibility criteria were included in this non-randomized comparative study. Control group was recruited retrospectively. nCRT (50.40 Gy/28 fr. plus capecitabine 825 mg/m2 twice daily) was administered to both groups before surgery. In the case group, HDR-BRT (8 Gy/2 fr.) was supplemented after chemoradiation. Surgery was done 6-8 weeks after completion of neo-adjuvant therapy. Pathologic complete response (pCR) was the study’s primary endpoint.

Results:
From 44 patients in the case and control groups, pCR was 11 (50%) and 8 (36.4%), respectively (p = 0.27). According to Ryan’s grading system, tumor regression grade (TRG) TRG1, TRG2, and TRG3 were 16 (72.7%), 2 (9.1%), and 4 (18.2%) in the case, and 10 (45.5%), 7 (31.8%), and 5 (22.7%) in the control group (p = 0.118). T down-staging was found in 19 (86.4%) and 13 (59.1%) patients in the case and control groups, respectively. No grade > 2 toxicity was identified in both the groups. Organ preservation was achieved in 42.8% and 15.3% in the case and control arm (p = 0.192). In the case group, 8-year overall survival (OS) and disease-free survival (DFS) were 89% (95% CI: 73-100%) and 78% (95% CI: 58-98%), respectively. Our study did not reach median OS and median DFS.

Conclusions:
Treatment schedule was well-tolerated, and neo-adjuvant HDR-BRT could achieve better T down-staging as a boost comparing with nCRT, without significant complication. However, the optimal dose and fractions in the context of HDR-BRT boost needs further studies.

keywords:

brachytherapy, neo-adjuvant chemoradiotherapy, boost, dose escalation, rectal cancer

 
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