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A systematic review comparing radiation toxicity after various endorectal techniques
An-Sofie Verrijssen1, Thirza Opbroek2, Murillo Bellezzo3
1Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
Brachytherapy
|November 7, 2018
Summary
Endorectal radiation boost techniques like contact X-ray therapy (CXT) and brachytherapy (BT) increase complete response rates for rectal cancer. However, toxicity data is limited, with BT showing higher rates of Grade 3 rectal and some urinary toxicity.
Area of Science:
- Oncology
- Radiation Oncology
- Surgical Oncology
Background:
- Neoadjuvant chemoradiation for rectal cancer achieves complete response in 15%-20% of patients.
- Complete response allows patients to potentially avoid major surgery via a watch-and-wait approach.
- Radiation boost dose escalation is shown to improve complete response rates.
Purpose of the Study:
- To systematically review and compare acute and late toxicity data for contact X-ray therapy (CXT) and brachytherapy (BT) used as endorectal radiation boost techniques for rectal cancer.
- To address the limited information on treatment-related toxicity associated with these rectal cancer radiation boost methods.
Main Methods:
- A systematic review of 38 studies involving 3682 patients who received endorectal radiation techniques for rectal cancer.
- Analysis focused on reported acute and late toxicities, including Grade 3 or higher events.
Main Results:
- ≥ Grade 3 rectal toxicity occurred in 2.9% of patients treated with CXT only and 6.3% treated with brachytherapy (BT) only.
- Brachytherapy (BT) also resulted in Grade 3 urinary toxicity in one patient.
- Toxicity from CXT was limited to the rectum, while BT also led to urogenital and skin toxicities.
Conclusions:
- All reviewed endorectal radiation techniques reported some Grade 3 or higher toxicity.
- Non-uniform reporting of techniques, doses, and volumes hindered direct toxicity comparisons.
- Standardized guidelines for dose reporting, prescription, volume specification, and toxicity reporting are urgently needed in endorectal radiation for rectal cancer.
