Contact X-ray brachytherapy (CXB) as a salvage treatment for rectal cancer patients who developed local tumor re-growth after watch-and-wait approach

IF 1.1 4区 医学 Q4 ONCOLOGY Journal of Contemporary Brachytherapy Pub Date : 2024-04-23 DOI:10.5114/jcb.2024.139049
Ngu Wah Than, Mark Pritchard, Carrie. A. Duckworth, David M. Hughes, Helen Wong, Rajaram Sripadam, Arthur Sun Myint
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Abstract

Purpose:
A watch-and-wait approach is an alternative to surgery for rectal cancer patients who have achieved a clinical complete response (cCR) following neoadjuvant (chemo)radiotherapy. However, approximately 25-38% of patients experience subsequent local tumor re-growth that requires salvage surgery. We evaluated the effectiveness of contact X-ray brachytherapy (CXB) as an alternative method of salvage therapy for those patients who were either unfit for or refused surgery. Oncological outcomes, tolerability, and feasibility of subsequent surgery for local treatment failure following CXB were reported.

Material and methods:
From 2009-2021, all patients treated with CXB as salvage therapy for local rectal cancer re-growth after watch-and-wait approach at our center were analyzed.

Results:
Contact X-ray brachytherapy as a salvage treatment (range, 90-110 Gy) was offered to 56 patients who experienced tumor re-growth following (chemo)radiation and watch-and-wait protocol. Median age was 76 (IQR = 66-83) years. Most patients (82%) had early-stage re-growth (ycT1/ycT2, ycN0), and 18% had more advanced stages (ycT3/ycT4, ycN0). After a median of 37-month follow-up (IQR = 19-53), 48% of patients who had early-stage re-growth achieved a sustained complete remission after CXB compared with 20% of those who had more advanced tumor stages. Disease-free and overall survivals for the whole cohort were 69% and 100% at 1-year, 51% and 82% at 3-year, and 51% and 65% at 5-years. CXB effectively controlled local re-growth-related symptoms. Mild post-CXB side effects occurred in 18% of cases. All (100%) eight patients who developed further local relapse, and 29% of those who had residual disease post-CXB salvage were successfully managed with subsequent surgery.

Conclusions:
Contact X-ray brachytherapy offers a new treatment option for patients in this situation whose other therapy options are not suitable for or refused initial surgery. Early local tumor re-growth responded best with minimal treatment-related toxicity and excellent symptom control. Disease-free and overall survival rates were acceptable, and delaying surgical salvage for local re-growth did not compromise patients’ eventual long-term outcomes.

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将接触式 X 射线近距离放射治疗 (CXB) 作为观察和等待方法后出现局部肿瘤再生长的直肠癌患者的挽救治疗方法
目的:对于在新辅助(化疗)放疗后获得临床完全反应(cCR)的直肠癌患者,观察和等待是手术治疗的一种替代方法。然而,约有25%-38%的患者随后会出现局部肿瘤再次生长,需要进行挽救性手术。我们评估了接触式X射线近距离放射治疗(CXB)作为不适合或拒绝手术的患者的另一种挽救治疗方法的有效性。材料和方法:分析了 2009-2021 年期间,本中心所有采用 CXB 作为挽救疗法治疗观察-等待法后局部直肠癌再生长的患者。结果:56 名患者在接受(化疗)放疗和观察-等待方案后出现肿瘤再生长,我们为他们提供了接触式 X 射线近距离放射治疗作为挽救疗法(范围为 90-110 Gy)。中位年龄为 76 岁(IQR = 66-83 岁)。大多数患者(82%)为早期再生长(ycT1/ycT2,ycN0),18%为晚期(ycT3/ycT4,ycN0)。经过中位数为 37 个月的随访(IQR = 19-53),48% 的早期再生长患者在 CXB 后获得了持续的完全缓解,而 20% 的晚期肿瘤患者在 CXB 后获得了持续的完全缓解。整个组群的无病生存率和总生存率分别为:1年69%和100%,3年51%和82%,5年51%和65%。CXB有效控制了局部再生长相关症状。18%的病例在接受 CXB 治疗后出现了轻微的副作用。结论:接触式X射线近距离放射治疗为不适合或拒绝初次手术的患者提供了一种新的治疗方案。早期局部肿瘤再生长反应最佳,治疗相关毒性最小,症状控制良好。无病生存率和总生存率均可接受,因局部肿瘤再生长而推迟手术抢救不会影响患者最终的长期疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Contemporary Brachytherapy
Journal of Contemporary Brachytherapy ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
2.40
自引率
14.30%
发文量
54
审稿时长
16 weeks
期刊介绍: The “Journal of Contemporary Brachytherapy” is an international and multidisciplinary journal that will publish papers of original research as well as reviews of articles. Main subjects of the journal include: clinical brachytherapy, combined modality treatment, advances in radiobiology, hyperthermia and tumour biology, as well as physical aspects relevant to brachytherapy, particularly in the field of imaging, dosimetry and radiation therapy planning. Original contributions will include experimental studies of combined modality treatment, tumor sensitization and normal tissue protection, molecular radiation biology, and clinical investigations of cancer treatment in brachytherapy. Another field of interest will be the educational part of the journal.
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