Organ Preservation Using Contact Radiotherapy for Early Rectal Cancer: Outcomes of Patients Treated at a Single Centre in the UK. Issue 3 (March 2017)

• Record Type: Journal Article
• Authors: Dhadda, A.S.; Martin, A.; Killeen, S.; Hunter, I.A.
• Is Part Of: Clinical oncology. Volume 29:Issue 3(2017)
• Page Start: 198
• Page End: 204
• Publication Date: 2017-03
• Subjects: Organ preservation -- radiotherapy -- rectal cancer; Oncology -- Periodicals; Tumors -- Periodicals; Cancer -- Treatment -- Periodicals; Radiotherapy -- Periodicals; Neoplasms -- Periodicals; Cancer -- Radiotherapy; Cancer -- Treatment; Oncology; Medical radiology; Radiotherapy; Tumors; Electronic journals; Periodicals; 616.994
• DOI: 10.1016/j.clon.2016.09.014
• Languages: English
• ISSNs: 0936-6555

Abstract

Abstract: Aims: Contact radiotherapy for early rectal cancer uses 50 kV X-rays to treat rectal cancers under direct vision. We present data of a series of patients treated at a single centre with prospective follow-up and functional assessment. Materials and methods: All patients were treated at the Queen's Centre for Oncology, Hull, UK between September 2011 and October 2015. Patients received a biopsy, magnetic resonance imaging (MRI) of the liver/pelvis, computed tomography of the chest and endorectal ultrasound. Patients were deemed to be either unfit for radical surgery or refused it due to the need for a permanent stoma. Follow-up consisted of 3 monthly flexible sigmoidoscopy and MRI of the liver/pelvis and 12 monthly computed tomography of the chest. Results: In total, 42 patients were treated with contact radiotherapy ± external beam chemo/radiotherapy without any primary surgical excision. The median age was 78 years (range 50–94 years). Local recurrence-free survival was 88%, disease-free survival was 86% and overall survival was 88% with a median follow-up of 24 months (range 5–54 months). The median time to recurrence was 12 months (range 4–14 months). The estimated 30 day surgical mortality for this cohort with radical surgery was 12%. Mortality from the contact radiotherapy procedure was 0%. Functional outcomes as investigated by the Low Anterior Resection Syndrome (LARS) score were good, with 65% having no LARS. Conclusions: Contact radiotherapy for early rectal cancer is a safe, well-tolerated outpatient procedure, allowing organ preservation, with excellent oncological and functional outcomes. For elderly co-morbid patients with suitable rectal cancers this should be considered as a standard of care. Highlights: Contact radiotherapy allows organ preservation in selected early rectal cancer. Median 2 year local recurrence-free and overall survival was 88%. Estimated 30 day mortality with radical surgery in this group was 12%. 92% of patients were satisfied with their bowel function after treatment. Contact radiotherapy should be considered standard of care in such a group of patients.