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

Arefeh Saeedian; Marzieh Lashkari; Reza Ghalehtaki; Maryam Taherioun; Mahdieh Razmkhah; Ali Kazemian; Mahdi Aghili

doi:10.5114/jcb.2023.127051

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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2/2023
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abstract:

Original paper

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

Arefeh Saeedian

^{1, 2}

,

Marzieh Lashkari

^{1, 2}

,

Reza Ghalehtaki

^{1, 2}

,

Maryam Taherioun

^{1, 2}

,

Mahdieh Razmkhah

^{1, 2}

,

Ali Kazemian

^{1, 2}

,

Mahdi Aghili

^{1, 2}

Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
Department of Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran

J Contemp Brachytherapy 2023; 15, 2: 117–122

DOI: https://doi.org/10.5114/jcb.2023.127051

Online publish date: 2023/04/28

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AMA

Saeedian A, Lashkari M, Ghalehtaki R, et al. Complication and response assessment 
of high-dose-rate endorectal brachytherapy boost in neo-adjuvant chemoradiotherapy of locally advanced rectal cancer with long-term outcomes. Journal of Contemporary Brachytherapy. 2023;15(2):117-122. doi:10.5114/jcb.2023.127051.

APA

Saeedian, A., Lashkari, M., Ghalehtaki, R., Taherioun, M., Razmkhah, M.,  & Kazemian, A. et al. (2023). Complication and response assessment 
of high-dose-rate endorectal brachytherapy boost in neo-adjuvant chemoradiotherapy of locally advanced rectal cancer with long-term outcomes. Journal of Contemporary Brachytherapy, 15(2), 117-122. https://doi.org/10.5114/jcb.2023.127051

Chicago

Saeedian, Arefeh, Marzieh Lashkari, Reza Ghalehtaki, Maryam Taherioun, Mahdieh Razmkhah, Ali Kazemian,  and Mahdi Aghili. 2023. "Complication and response assessment 
of high-dose-rate endorectal brachytherapy boost in neo-adjuvant chemoradiotherapy of locally advanced rectal cancer with long-term outcomes". Journal of Contemporary Brachytherapy 15 (2): 117-122. doi:10.5114/jcb.2023.127051.

Harvard

Saeedian, A., Lashkari, M., Ghalehtaki, R., Taherioun, M., Razmkhah, M., Kazemian, A.,  and Aghili, M. (2023). Complication and response assessment 
of high-dose-rate endorectal brachytherapy boost in neo-adjuvant chemoradiotherapy of locally advanced rectal cancer with long-term outcomes. Journal of Contemporary Brachytherapy, 15(2), pp.117-122. https://doi.org/10.5114/jcb.2023.127051

MLA

Saeedian, Arefeh et al. "Complication and response assessment 
of high-dose-rate endorectal brachytherapy boost in neo-adjuvant chemoradiotherapy of locally advanced rectal cancer with long-term outcomes." Journal of Contemporary Brachytherapy, vol. 15, no. 2, 2023, pp. 117-122. doi:10.5114/jcb.2023.127051.

Vancouver

Saeedian A, Lashkari M, Ghalehtaki R, Taherioun M, Razmkhah M, Kazemian A et al. Complication and response assessment 
of high-dose-rate endorectal brachytherapy boost in neo-adjuvant chemoradiotherapy of locally advanced rectal cancer with long-term outcomes. Journal of Contemporary Brachytherapy. 2023;15(2):117-122. doi:10.5114/jcb.2023.127051.

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.

keywords:

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

Arefeh Saeedian 1, 2 , Marzieh Lashkari 1, 2 , Reza Ghalehtaki 1, 2 , Maryam Taherioun 1, 2 , Mahdieh Razmkhah 1, 2 , Ali Kazemian 1, 2 , Mahdi Aghili 1, 2

brachytherapy, neo-adjuvant chemoradiotherapy, boost, dose escalation, rectal cancer

Arefeh Saeedian

^{1, 2}

,

Marzieh Lashkari

^{1, 2}

,

Reza Ghalehtaki

^{1, 2}

,

Maryam Taherioun

^{1, 2}

,

Mahdieh Razmkhah

^{1, 2}

,

Ali Kazemian

^{1, 2}

,

Mahdi Aghili

^{1, 2}