CT-based adaptive high-dose-rate endorectal brachytherapy in the preoperative treatment of locally advanced rectal cancer: Technical and practical aspects

Evaluation of clinical and endoscopic toxicity after external beam radiotherapy and endorectal brachytherapy in elderly patients with rectal cancer treated in the HERBERT study

“…Future use of additional balloon spacing, shielding, daily image guidance and MRI during brachytherapy can further improve conformal dose delivery, with increased sparing of organs at risk. (31)(32)(33)(34) Overall survival is difficult to interpret in this mainly elderly population with severe comorbidity. A median overall survival of 33 months was favorable compared to the series described by Corner et al (median OS 18 months).…”

Adaptive radiation dose escalation in rectal adenocarcinoma: a review

“…Endorectal brachytherapy has advanced from a relatively crude procedure that irradiates the entire rectum circumference, to a highly conformal technique with the use of 3D-CT planning and partial shielding to spare normal tissue adjacent to and opposite the rectal tumor (55). Studies on the use of brachytherapy as the sole neoadjuvant radiation treatment for rectal cancer are limited with the total doses reaching 26 Gy (56,57). Endorectal brachytherapy has also been used to escalate radiation doses beyond 50.4 Gy in conjunction with EBRT with mixed results.…”

MRI visibility of gold fiducial markers for image-guided radiotherapy of rectal cancer

“…Tumor dose can be increased by applying a boost with external beam radiotherapy (EBRT), high-dose rate endorectal brachytherapy (HDREBT) or contact therapy. Current clinical practice for posi-tion verification is megavolt imaging or cone beam computed tomography (CBCT) during EBRT and a radiograph or CT during HDREBT [12][13][14][15]. However, these imaging modalities suffer from limited soft tissue contrast which makes position verification of the gross tumor volume (GTV) difficult [16,17].…”