Organ Preservation Using Contact Radiotherapy for Early Rectal Cancer: Outcomes of Patients Treated at a Single Centre in the UK

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 29; no. 3; pp. 198 - 204
• Main Authors: Dhadda, A.S, Martin, A, Killeen, S, Hunter, I.A
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-03-2017
• Subjects: Aged; Aged, 80 and over; Disease-Free Survival; Female; Hematology, Oncology and Palliative Medicine; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Organ preservation; Prospective Studies; Radiology; radiotherapy; Radiotherapy - methods; rectal cancer; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Tomography, X-Ray Computed; Treatment Outcome; radiotherapy; Organ preservation; rectal cancer
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2016.09.014

Abstract Aims Contact radiotherapy for early rectal cancer uses 50 kV X-rays to treat rectal cancers under direct vision. We present data of a series of patients treated at a single centre with prospective follow-up and functional assessment. Materials and methods All patients were treated at the Queen's Centre for Oncology, Hull, UK between September 2011 and October 2015. Patients received a biopsy, magnetic resonance imaging (MRI) of the liver/pelvis, computed tomography of the chest and endorectal ultrasound. Patients were deemed to be either unfit for radical surgery or refused it due to the need for a permanent stoma. Follow-up consisted of 3 monthly flexible sigmoidoscopy and MRI of the liver/pelvis and 12 monthly computed tomography of the chest. Results In total, 42 patients were treated with contact radiotherapy ± external beam chemo/radiotherapy without any primary surgical excision. The median age was 78 years (range 50–94 years). Local recurrence-free survival was 88%, disease-free survival was 86% and overall survival was 88% with a median follow-up of 24 months (range 5–54 months). The median time to recurrence was 12 months (range 4–14 months). The estimated 30 day surgical mortality for this cohort with radical surgery was 12%. Mortality from the contact radiotherapy procedure was 0%. Functional outcomes as investigated by the Low Anterior Resection Syndrome (LARS) score were good, with 65% having no LARS. Conclusions Contact radiotherapy for early rectal cancer is a safe, well-tolerated outpatient procedure, allowing organ preservation, with excellent oncological and functional outcomes. For elderly co-morbid patients with suitable rectal cancers this should be considered as a standard of care.