Brief Article
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World J Gastroenterol. Sep 21, 2010; 16(35): 4436-4442
Published online Sep 21, 2010. doi: 10.3748/wjg.v16.i35.4436
High-dose-rate intraluminal brachytherapy during preoperative chemoradiation for locally advanced rectal cancers
Mutahir Ali Tunio, Mansoor Rafi, Altaf Hashmi, Rehan Mohsin, Abdul Qayyum, Mujahid Hasan, Amjad Sattar, Muhammad Mubarak
Mutahir Ali Tunio, Mansoor Rafi, Department of Radiation Oncology, Sindh Institute of Urology and Transplantation, 74200-Karachi, Pakistan
Altaf Hashmi, Rehan Mohsin, Department of Surgical Oncology, Sindh Institute of Urology and Transplantation, 74200-Karachi, Pakistan
Abdul Qayyum, Department of Medical Oncology, Sindh Institute of Urology and Transplantation, 74200-Karachi, Pakistan
Mujahid Hasan, Department of Gastroenterology, Sindh Institute of Urology and Transplantation, 74200-Karachi, Pakistan
Amjad Sattar, Department of Radiology, Sindh Institute of Urology and Transplantation, 74200-Karachi, Pakistan
Muhammad Mubarak, Department of Pathology, Sindh Institute of Urology and Transplantation, 74200-Karachi, Pakistan
Author contributions: Rafi M, Hashmi A and Mohsin R performed the data collection; Qayyum A, Sattar A and Hasan M performed the statistical analysis; Mubarak M performed the histopathological analysis and was also involved in editing the manuscript; Tunio MA designed the study and wrote the manuscript.
Correspondence to: Mutahir Ali Tunio, MBBS, FCPS (Radiotherapy), Assistant Professor, Department of Radiation Oncology, Sindh Institute of Urology and Transplantation, 74200-Karachi, Pakistan. drmutahirtonio@hotmail.com
Telephone: +92-21-2745801 Fax: +92-21-9215469
Received: April 30, 2010
Revised: May 24, 2010
Accepted: May 31, 2010
Published online: September 21, 2010
Abstract

AIM: To determine the feasibility and safety of high dose rate intraluminal brachytherapy (HDR-ILBT) boost during preoperative chemoradiation for rectal cancer.

METHODS: Between 2008 and 2009, thirty-six patients with locally advanced rectal cancer (≥ T3 or N+), were treated initially with concurrent capecitabine (825 mg/m2 oral twice daily) and pelvic external beam radiotherapy (EBRT) (45 Gy in 25 fractions), then were randomized to group A; HDR-ILBT group (n = 17) to receive 5.5-7 Gy × 2 to gross tumor volume (GTV) and group B; EBRT group (n = 19) to receive 5.4 Gy × 3 fractions to GTV with EBRT. All patients underwent total mesorectal excision.

RESULTS: Grade 3 acute toxicities were registered in 12 patients (70.6%) in group A and in 8 (42.1%) in group B. Complete pathologic response of T stage (ypT0) in group A was registered in 10 patients (58.8%) and in group B, 3 patients (15.8%) had ypT0 (P < 0.0001). Sphincter preservation was reported in 6/9 patients (66.7%) in group A and in 5/10 patients (50%) in group B (P < 0.01). Overall radiological response was 68.15% and 66.04% in Group A and B, respectively. During a median follow up of 18 mo, late grade 1 and 2 sequelae were registered in 3 patients (17.6%) and 4 patients (21.1%) in the groups A and B, respectively.

CONCLUSION: HDR-ILBT was found to be effective dose escalation technique in preoperative chemoradiation for rectal cancers, with higher response rates, downstaging and with manageable acute toxicities.

Keywords: High dose rate, Intraluminal brachytherapy boost, Locally advanced rectal cancer, Preoperative chemoradiation