Clinical response assessment after contact X-Ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer T2-T3 M0: The time/dose factor influence
Introduction: A neoadjuvant treatment aimed at rectal preservation should achieve a clinical complete response. This study comparing neoadjuvant treatment initiated with Contact X-ray (CXB) or External Beam radiotherapy (EBRT) is evaluating the influence of the time/dose parameter on clinical respon...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-09-01
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| Series: | Clinical and Translational Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S240563082030063X |
| _version_ | 1818656674356920320 |
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| author | Karen Benezery Lucile Montagne Ludovic Evesque Renaud Schiappa Jean-Michel Hannoun-Levi Eric Francois Brice Thamphya Jean-Pierre Gerard |
| author_facet | Karen Benezery Lucile Montagne Ludovic Evesque Renaud Schiappa Jean-Michel Hannoun-Levi Eric Francois Brice Thamphya Jean-Pierre Gerard |
| author_sort | Karen Benezery |
| collection | DOAJ |
| description | Introduction: A neoadjuvant treatment aimed at rectal preservation should achieve a clinical complete response. This study comparing neoadjuvant treatment initiated with Contact X-ray (CXB) or External Beam radiotherapy (EBRT) is evaluating the influence of the time/dose parameter on clinical response during the first six months. Materials and methods: This retrospective consecutive series included T2-3 rectal adenocarcinoma staged using digital examination (DRE), endoscopy, magnetic radiation imaging and/or endorectal ultrasound. All patients were treated with organ preservation intent. Treatment protocol combined CXB (80–110 Gy/3–4 fractions) and EBRT ± concurrent capecitabine. In tumor exceeding 3.5 cm treatment was often initiated using EBRT. Clinical response was assessed (DRE, proctoscopy ± imaging) at very close interval between 2 weeks and 6 months after treatment initiation. Results: Between 2002 and 2017, 61 patients (T2: 31; T3: 30) M0 (median age: 76 years) were treated. Treatment was initiated in 40 patients (T2: 28, T3: 12) with contact X-ray and in 21 (T2: 4, T3: 17) with EBRT. Using contact X-ray or EBRT first treatment, clinical complete (or near complete) response at week 14(±1) was respectively 88% [95CI:74–96] and 33% [95CI:15–57]. In multivariate analysis the treatment chronology was the most significant factor influencing cCR (OR: 7.53). At 6 months, with contact X-ray first all patients were in clinical complete response and five with EBRT remained in partial response. With 61 months median follow-up time, the local recurrence rate was 10% [95% CI: 6–16] at 5 years. T3 and fungating tumors were at higher risk of local recurrence. Organ preservation with good function was achieved in 95% of cases. Conclusion: This non randomized study tends to show that in early T2-3 tumors, a strategy using upfront contact therapy, which is reducing the overall treatment time, is an option allowing a more favorable outcome than EBRT first. |
| first_indexed | 2024-12-17T03:29:20Z |
| format | Article |
| id | doaj.art-6631fadf27ea4b07bb11ed88e6737d3b |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-12-17T03:29:20Z |
| publishDate | 2020-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-6631fadf27ea4b07bb11ed88e6737d3b2022-12-21T22:05:18ZengElsevierClinical and Translational Radiation Oncology2405-63082020-09-01249298Clinical response assessment after contact X-Ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer T2-T3 M0: The time/dose factor influenceKaren Benezery0Lucile Montagne1Ludovic Evesque2Renaud Schiappa3Jean-Michel Hannoun-Levi4Eric Francois5Brice Thamphya6Jean-Pierre Gerard7Department of Radiotherapy, Centre Antoine-LACASSAGNE – University Côte d’Azur, Nice, FranceDepartment of Radiotherapy, Centre Antoine-LACASSAGNE – University Côte d’Azur, Nice, FranceDepartment of Medical Oncology, Centre Antoine-LACASSAGNE – University Côte d’Azur, Nice, FranceDepartment of Statistics, Centre Antoine-LACASSAGNE – University Côte d’Azur, Nice, FranceDepartment of Radiotherapy, Centre Antoine-LACASSAGNE – University Côte d’Azur, Nice, FranceDepartment of Medical Oncology, Centre Antoine-LACASSAGNE – University Côte d’Azur, Nice, FranceDepartment of Statistics, Centre Antoine-LACASSAGNE – University Côte d’Azur, Nice, FranceDepartment of Radiotherapy, Centre Antoine-LACASSAGNE – University Côte d’Azur, Nice, France; Corresponding author at: Centre Antoine-Lacassagne, 33 Avenue de Valombrose, 06189 Nice Cedex, France.Introduction: A neoadjuvant treatment aimed at rectal preservation should achieve a clinical complete response. This study comparing neoadjuvant treatment initiated with Contact X-ray (CXB) or External Beam radiotherapy (EBRT) is evaluating the influence of the time/dose parameter on clinical response during the first six months. Materials and methods: This retrospective consecutive series included T2-3 rectal adenocarcinoma staged using digital examination (DRE), endoscopy, magnetic radiation imaging and/or endorectal ultrasound. All patients were treated with organ preservation intent. Treatment protocol combined CXB (80–110 Gy/3–4 fractions) and EBRT ± concurrent capecitabine. In tumor exceeding 3.5 cm treatment was often initiated using EBRT. Clinical response was assessed (DRE, proctoscopy ± imaging) at very close interval between 2 weeks and 6 months after treatment initiation. Results: Between 2002 and 2017, 61 patients (T2: 31; T3: 30) M0 (median age: 76 years) were treated. Treatment was initiated in 40 patients (T2: 28, T3: 12) with contact X-ray and in 21 (T2: 4, T3: 17) with EBRT. Using contact X-ray or EBRT first treatment, clinical complete (or near complete) response at week 14(±1) was respectively 88% [95CI:74–96] and 33% [95CI:15–57]. In multivariate analysis the treatment chronology was the most significant factor influencing cCR (OR: 7.53). At 6 months, with contact X-ray first all patients were in clinical complete response and five with EBRT remained in partial response. With 61 months median follow-up time, the local recurrence rate was 10% [95% CI: 6–16] at 5 years. T3 and fungating tumors were at higher risk of local recurrence. Organ preservation with good function was achieved in 95% of cases. Conclusion: This non randomized study tends to show that in early T2-3 tumors, a strategy using upfront contact therapy, which is reducing the overall treatment time, is an option allowing a more favorable outcome than EBRT first.http://www.sciencedirect.com/science/article/pii/S240563082030063XOrgan preservationRectal cancerNeoadjuvant treatmentContact X-ray brachytherapyWatch and Wait |
| spellingShingle | Karen Benezery Lucile Montagne Ludovic Evesque Renaud Schiappa Jean-Michel Hannoun-Levi Eric Francois Brice Thamphya Jean-Pierre Gerard Clinical response assessment after contact X-Ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer T2-T3 M0: The time/dose factor influence Clinical and Translational Radiation Oncology Organ preservation Rectal cancer Neoadjuvant treatment Contact X-ray brachytherapy Watch and Wait |
| title | Clinical response assessment after contact X-Ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer T2-T3 M0: The time/dose factor influence |
| title_full | Clinical response assessment after contact X-Ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer T2-T3 M0: The time/dose factor influence |
| title_fullStr | Clinical response assessment after contact X-Ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer T2-T3 M0: The time/dose factor influence |
| title_full_unstemmed | Clinical response assessment after contact X-Ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer T2-T3 M0: The time/dose factor influence |
| title_short | Clinical response assessment after contact X-Ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer T2-T3 M0: The time/dose factor influence |
| title_sort | clinical response assessment after contact x ray brachytherapy and chemoradiotherapy for organ preservation in rectal cancer t2 t3 m0 the time dose factor influence |
| topic | Organ preservation Rectal cancer Neoadjuvant treatment Contact X-ray brachytherapy Watch and Wait |
| url | http://www.sciencedirect.com/science/article/pii/S240563082030063X |
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