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

E. C. Rijkmans*, B. van Triest, R. A. Nout, E. M. Kerkhof, J. Buijsen, T. Rozema, J. H. Franssen, L. A. Velema, M. S. Laman, A. Cats, C. A. M. Marijnen

*Corresponding author for this work

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12 Citations (Web of Science)

Abstract

Introduction: The HERBERT study evaluated a high-dose-rate endorectal brachytherapy boost (HDREBT) after EBRT in medically inoperable/elderly patients with rectal cancer. The response-rates are promising but not without risk of toxicity. The current analysis provides a comprehensive overview of patient reported, physician reported and endoscopically observed toxicity. Material and methods: A brachytherapy dose finding study was performed in 38 inoperable/elderly patients with T2-T4N0-1 rectal cancer. Patients received EBRT (13 x 3 Gy) followed by three weekly HDREBT applications (5-8 Gy). Toxicity was assessed via three methods: patient and physician (CTCAEv3) reported rectal symptoms and endoscopically. Wilcoxon's signed rank test, paired t-test and Spearman's correlation were used. Results: Patient reported bowel symptoms showed a marked increase at the end of EBRT and two weeks after HDREBT. Acute grade 2 and 3 proctitis occurred in 68.4% and 13.2% respectively while late grade 2 and >= 3 proctitis occurred in 48% and 40%. Endoscopic evaluation mainly showed erythema and telangiectasia. In three patients frank haemorrhage or ulceration occurred. Most severe toxicity was observed 12-18 months after treatment. Conclusion: For elderly patients with rectal cancer, definitive radiotherapy can provide good tumour response but has a substantial risk of toxicity. The potential benefit and risks of a HDREBT boost above EBRT alone must be further evaluated. (C) 2018 Elsevier B.V. All rights reserved.
Original languageEnglish
Pages (from-to)417-423
Number of pages7
JournalRadiotherapy and Oncology
Volume126
Issue number3
DOIs
Publication statusPublished - 1 Mar 2018

Keywords

  • Rectal cancer
  • Elderly
  • Endorectal brachytherapy
  • Definitive radiotherapy
  • Toxicity
  • PROSTATE-CANCER
  • RANDOMIZED-TRIAL
  • PROSPECTIVE MULTICENTER
  • CONFORMAL RADIOTHERAPY
  • ENDOCAVITARY RADIATION
  • COMPLETE RESPONSE
  • CHEMORADIATION
  • THERAPY
  • ADENOCARCINOMA
  • CARCINOMA

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