GEC ESTRO ACROP consensus recommendations for contact brachytherapy for rectal cancer

Stewart, Alexandra J.; Limbergen, Evert J. Van; Gérard, Jean-Pierre; Appelt, Ane L; Verhaegen, Frank; Berbée, Maaike; Vuong, T.; Brooker, Ciarna; Rockall, Tim; Myint, Arthur Sun

doi:10.1016/j.ctro.2021.12.004

Cited by 14 publications

(10 citation statements)

References 42 publications

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“…After an initial 45 Gy/25 fx with concurrent capecitabine, patients were randomized to receive a boost with conventional RT (9 Gy/5 fx over 1 week) versus Papillon contact x-ray brachytherapy (CXB; 90 Gy/3 fx over 4 weeks). 17 The authors conclude an CXB boost, when combined with CRT, increases the OP rate in early rectal adenocarcinoma, especially for tumors <3 cm. STAR-TREC, a rolling phase 2/3 trial, enrolled 120 patients with ≤4-cm diameter tumors, and the phase 2 portion randomly allotted patients 1:1:1 to total mesorectal excision (TME) or short-course radiation (25 Gy/5 fx) versus long-course CRT (LC-CRT; 50 Gy/25 fx with concurrent capecitabine).…”

Section: Gastrointestinalmentioning

confidence: 86%

American Society of Clinical Oncology 2022 Annual Meeting Highlights for Radiation Oncologists

Dove¹,

Ryckman²,

Chhabra³

et al. 2023

Advances in Radiation Oncology

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Section: Gastrointestinalmentioning

confidence: 86%

American Society of Clinical Oncology 2022 Annual Meeting Highlights for Radiation Oncologists

Dove¹,

Ryckman²,

Chhabra³

et al. 2023

Advances in Radiation Oncology

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“…Alongside existing consensus recommendations on the use of CXB in rectal cancer by the European Society for Therapeutic Radiology and Oncology [29], this guidance promotes wider access to CXB in Wales.…”

Section: Discussion and Con Clus Ionsmentioning

confidence: 99%

Low energy contact X‐ray brachytherapy for treatment of rectal cancer: a health technology appraisal by Health Technology Wales

Bennett,

Rao,

Batten

et al. 2024

Colorectal Disease

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AimHealth Technology Wales sought to evaluate the clinical and cost‐effectiveness of contact X‐ray brachytherapy (CXB) for early‐stage rectal cancer.MethodsRelevant studies were identified through systematic searches of MEDLINE, Embase, Cochrane Library and Scopus. A cost‐utility model was developed to estimate the cost‐effectiveness of CXB in National Health Service Wales, using results of the Organ Preservation in Early Rectal Adenocarcinoma (OPERA) trial. Patient perspectives were obtained through the Papillon Patient Support group and All‐Wales Cancer Network.ResultsThe OPERA randomized controlled trial showed that CXB improved complete response and organ preservation rates compared with external‐beam boost for people with T2–3b, N0–1, M0 rectal cancer who are fit for surgery. Managing more of this population non‐operatively after CXB was estimated to provide 0.2 quality‐adjusted life years at an additional cost of £887 per person. CXB was cost effective compared with external‐beam boost at a cost of £4463 per quality‐adjusted life year gained. This conclusion did not change in scenario analysis and CXB was cost effective in 91% of probabilistic sensitivity analyses. Patients valued receiving clear information on all available options to support their individual treatment choices. The detrimental impact of a stoma on quality of life led some patients to reject the idea that surgery was their only option.ConclusionThis evidence review and cost‐utility analysis indicates that CXB is likely to be clinically and cost effective, as part of a watch and wait strategy for adults fit for surgery. Wider access to CXB is supported by patient testimonies.

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“…As such, performing CXB according to the treatment schedule of the OPERA trial, irrespectively of the tumor response following a 2–3-week interval after neoadjuvant (chemo)radiotherapy, may result in overtreatment in a substantial number of patients who may continue on to a cCR following conventional (chemo)radiotherapy only [ 21 ]. Due to advancing insight and the results of the present study, the authors nowadays use more strict selection criteria for treatment with CXB aiming at organ preservation, where patients with a residual tumor of more than 3 cm and/or an interval of more than 3 months after (chemo)radiotherapy are generally no longer considered for CXB, in accordance with the ESTRO consensus recommendations for CXB [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Features on Endoscopy and MRI after Treatment with Contact X-ray Brachytherapy for Rectal Cancer: Explorative Results

Custers

Maas

Lambregts

et al. 2022

Cancers

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After neoadjuvant (chemo)radiotherapy for rectal cancer, contact X-ray brachytherapy (CXB) can be applied aiming at organ preservation. This explorative study describes the early features on endoscopy and MRI after CXB. Patients treated with CXB following (chemo)radiotherapy and a follow-up of ≥12 months were selected. Endoscopy and MRI were performed every 3 months. Expert readers scored all the images according to structured reporting templates. Thirty-six patients were included, 15 of whom obtained a cCR. On endoscopy, the most frequently observed feature early in follow-up was an ulcer, regardless of whether patients developed a cCR. A flat, white scar and tumor mass were common at 6 months. Focal tumor signal on T2W-MRI and mass-like high signal on DWI were generally absent in patients with a cCR. An ulceration on T2W-MRI and “reactive” mucosal signal on DWI were observed early in follow-up regardless of the final tumor response. The distinction between a cCR and a residual tumor generally can be made at 6 months. Features associated with a residual tumor are tumor mass on endoscopy, focal tumor signal on T2W-MRI, and mass-like high signal on DWI. Early recognition of these features is necessary to identify patients who will not develop a cCR as early as possible.

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GEC ESTRO ACROP consensus recommendations for contact brachytherapy for rectal cancer

Cited by 14 publications

References 42 publications

American Society of Clinical Oncology 2022 Annual Meeting Highlights for Radiation Oncologists

American Society of Clinical Oncology 2022 Annual Meeting Highlights for Radiation Oncologists

Low energy contact X‐ray brachytherapy for treatment of rectal cancer: a health technology appraisal by Health Technology Wales

Features on Endoscopy and MRI after Treatment with Contact X-ray Brachytherapy for Rectal Cancer: Explorative Results

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