A systematic review comparing radiation toxicity after various endorectal techniques

An-Sofie Verrijssen*, Thirza Opbroek, Murillo Bellezzo, Gabriel P. Fonseca, Frank Verhaegen, Jean-Pierre Gerard, Arthur Sun Myint, Evert J. Van Limbergen, Maaike Berbee

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Citations (Web of Science)

Abstract

PURPOSE: A clinical complete response is seen after neoadjuvant chemoradiation for rectal tumors in 15%-20% of patients. These patients can potentially be spared mutilating total mesorectal excision surgery through a watch-and-wait policy. Recent studies show that dose escalation by a radiation boost increases the clinical complete response rate. The boost dose to the tumor can be administered through external beam radiotherapy or through internal radiotherapy using techniques like contact therapy, low-dose-rate or high-dose-rate brachytherapy (BT). However, limited information is available concerning treatment-related toxicity of these techniques. With this systematic review, we aim to summarize and compare published data concerning acute and late toxicity after contact X-ray therapy (CXT) and BT for rectal cancer.

METHODS AND MATERIALS/RESULTS: Thirty-eight studies reporting toxicity after endorectal radiation techniques for rectal cancer were included, resulting in 3682 patients for analysis. Direct comparison of toxicity by the different radiation modes was hampered by various combinations of endorectal techniques, a lack of clear reporting of toxicity scores, dose prescription, technique used, and treated volumes. >= Grade 3 rectal toxicity was reported in 2.9% of patients having received only CXT; 6.3% of patients who received only BT had Grade 3 rectal toxicity, and BT also caused Grade 3 urinary toxicity in 1 patient.

CONCLUSION: All techniques reported some >= Grade 3 toxicity. Toxicity after CXT was confined to the rectum, whereas after BT, urogenital toxicity and skin toxicity were seen as well. Unfortunately, few specific conclusions could be drawn regarding the dose-related risk of toxicity for the various techniques due to nonuniform reporting strategies and missing information. To enable future comparisons and improvements, the endorectal radiation field urgently needs consensus guidelines on dose reporting, dose prescription, treatment volume specification, and toxicity reporting. (C) 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)71-86
Number of pages16
JournalBrachytherapy
Volume18
Issue number1
DOIs
Publication statusPublished - 2019

Keywords

  • Endorectal brachytherapy
  • HDR
  • LDR
  • Contact therapy
  • Toxicity
  • Rectal cancer
  • ADVANCED RECTAL-CANCER
  • X-RAY BRACHYTHERAPY
  • QUALITY-OF-LIFE
  • ENDOCAVITARY IRRADIATION
  • INTRALUMINAL BRACHYTHERAPY
  • ORGAN PRESERVATION
  • PREOPERATIVE CHEMORADIATION
  • ABDOMINOPERINEAL RESECTION
  • SPHINCTER PRESERVATION
  • CONSERVATIVE TREATMENT

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