TY  - JOUR
A1  - Fleischmann, Maximilian
A1  - Diefenhardt, Markus
A1  - Trommel, Martin
A1  - Scherf, Christian
A1  - Ramm, Ulla
A1  - Chatzikonstantinou, Georgios
A1  - Fokas, Emmanouil
A1  - Rödel, Claus
A1  - Tselis, Nikolaos
T1  - Image-guided high-dose-rate brachytherapy for rectal cancer: technical note and first clinical experience on an organ-preserving approach
T2  - Strahlentherapie und Onkologie
N2  - Purpose: As the population ages, the incidence of rectal cancer among elderly patients is rising. Due to the risk of perioperative morbidity and mortality, alternative nonoperative treatment options have been explored in elderly and frail patients who are clinically inoperable or refuse surgery.
Methods: Here we present technical considerations and first clinical experience after treating a cohort of six rectal cancer patients (T1‑3, N0‑1, M0; UICC stage I-IIIB) with definitive external-beam radiation therapy (EBRT) followed by image-guided, endorectal high-dose-rate brachytherapy (HDR-BT). Patients were treated with 10–13 × 3 Gy EBRT followed by HDR-BT delivering 12–18 Gy in two or three fractions. Tumor response was evaluated using endoscopy and magnetic resonance imaging of the pelvis.
Results: Median age was 84 years. All patients completed EBRT and HDR-BT without any high-grade toxicity (> grade 2). One patient experienced rectal bleeding (grade 2) after 10 weeks. Four patients (67%) demonstrated clinical complete response (cCR) or near cCR, there was one partial response, and one residual tumor and hepatic metastasis 8 weeks after HDR-BT. The median follow-up time for all six patients is 42 weeks (range 8–60 weeks). Sustained cCR without evidence of local regrowth has been achieved in all four patients with initial (n)cCR to date.
Conclusion: Primary EBRT combined with HDR-BT is feasible and well tolerated with promising response rates in elderly and frail rectal cancer patients. The concept could be an integral part of a highly individualized and selective nonoperative treatment offered to patients who are not suitable for or refuse surgery.
KW  - Rectal cancer
KW  - Radiotherapy
KW  - Brachytherapy
KW  - Endoluminal
KW  - Endorectal
KW  - Nonoperative management
KW  - Organ preservation
KW  - Complete response
Y1  - 2022
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/69508
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-695088
SN  - 1439-099X
N1  - Open Access funding enabled and organized by Projekt DEAL
VL  - 198
IS  - 7
SP  - 654
EP  - 662
PB  - Springer Medizin
CY  - Berlin ; Heidelberg
ER  -