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

IF 1.1 4区 医学 Q4 ONCOLOGY Journal of Contemporary Brachytherapy Pub Date : 2023-04-01 DOI:10.5114/jcb.2023.127051
Arefeh Saeedian, Marzieh Lashkari, Reza Ghalehtaki, Maryam Taherioun, Mahdieh Razmkhah, Ali Kazemian, Mahdi Aghili
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引用次数: 1

Abstract

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.

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高剂量率直肠内近距离放疗促进局部晚期直肠癌新辅助放化疗的并发症和疗效评估。
目的:探讨高剂量率直肠内近距离放射治疗(HDR-BRT)在局部晚期直肠癌新辅助放化疗(nCRT)中的疗效、并发症和病理反应。材料和方法:44例符合资格标准的患者纳入了这项非随机比较研究。对照组回顾性招募。两组术前均给予nCRT (50.40 Gy/28 fr,加卡培他滨825 mg/m2,每日2次)。病例组在放化疗后补充HDR-BRT (8 Gy/2 fr.)。手术于新辅助治疗完成后6-8周进行。病理完全缓解(pCR)是研究的主要终点。结果:病例组和对照组44例患者中,pCR分别为11例(50%)和8例(36.4%),差异有统计学意义(p = 0.27)。根据Ryan分级系统,本组肿瘤消退等级(TRG) TRG1、TRG2、TRG3分别为16(72.7%)、2(9.1%)、4(18.2%),对照组为10(45.5%)、7(31.8%)、5(22.7%),差异有统计学意义(p = 0.118)。病例组和对照组分别有19例(86.4%)和13例(59.1%)患者出现T分期下降。两组均未发现2级以上毒性。病例组和对照组的器官保存率分别为42.8%和15.3% (p = 0.192)。在病例组中,8年总生存率(OS)和无病生存率(DFS)分别为89% (95% CI: 73-100%)和78% (95% CI: 58-98%)。我们的研究没有达到中位OS和中位DFS。结论:治疗方案耐受性良好,与nCRT相比,新辅助HDR-BRT可实现更好的T降期,无明显并发症。然而,在HDR-BRT增强的背景下,最佳剂量和分数需要进一步研究。
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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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