Clinical selection strategy for and evaluation of intra-operative brachytherapy in patients with locally advanced and recurrent rectal cancer

Esmée A Dijkstra; Véronique E M Mul; Patrick H J Hemmer; Klaas Havenga; Geke A P Hospers; Gursah Kats-Ugurlu; Jannet C Beukema; Maaike J Berveling; Mostafa El Moumni; Christina T Muijs; Boudewijn van Etten

doi:10.1016/j.radonc.2021.03.010

Clinical selection strategy for and evaluation of intra-operative brachytherapy in patients with locally advanced and recurrent rectal cancer

Esmée A Dijkstra, Véronique E M Mul, Patrick H J Hemmer, Klaas Havenga, Geke A P Hospers, Gursah Kats-Ugurlu, Jannet C Beukema, Maaike J Berveling, Mostafa El Moumni, Christina T Muijs, Boudewijn van Etten^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background and purpose: A radical resection of locally advanced rectal cancer (LARC) or recurrent rectal cancer (RRC) can be challenging. In case of increased risk of an R1 resection, intra-operative brachytherapy (IOBT) can be applied. We evaluated the clinical selection strategy for IOBT.

Materials and methods: Between February 2007 and May 2018, 132 LARC/RRC patients who were scheduled for surgery with IOBT standby, were evaluated. By intra-operative inspection of the resection margin and MR imaging, it was determined whether a resection was presumed to be radical. Frozen sections were taken on indication. In case of a suspected R1 resection, IOBT (1 x 10 Gy) was applied. Histopathologic evaluation, treatment and toxicity data were collected from medical records.

Results: Tumour was resected in 122 patients. IOBT was given in 42 patients of whom 54.8% (n = 23) had a histopathologically proven R1 resection. Of the 76 IOBT-omitted R0 resected patients, 17.1% (n = 13) had a histopathologically proven R1 resection. In 4 IOBT-omitted patients, a clinical R1/2 resection was seen. In total, correct clinical judgement occurred in 72.6% (n = 88) of patients. In LARC, 58.3% (n = 14) of patients were overtreated (R0, with IOBT) and 10.9% (n = 5) were undertreated (R1, without IOBT). In RRC, 26.5% (n = 9) of patients were undertreated.

Conclusion: In total, correct clinical judgement occurred in 72.6% (n = 88). However, in 26.5% (n = 9) RRC patients, IOBT was unjustifiedly omitted. IOBT is accompanied by comparable and acceptable toxicity. Therefore, we recommend IOBT to all RRC patients at risk of an R1 resection as their salvage treatment.

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Original language	English
Pages (from-to)	91-97
Number of pages	7
Journal	Radiotherapy and Oncology
Volume	159
Early online date	Mar-2021
DOIs	https://doi.org/10.1016/j.radonc.2021.03.010
Publication status	Published - Jun-2021

Keywords

Rectal neoplasms
Neoadjuvant therapy
Brachytherapy
Radiation oncology
Patient selection
Adverse effects
CONTAINING MULTIMODALITY TREATMENT
PREOPERATIVE RADIOTHERAPY
RADIATION-THERAPY
RESECTION MARGIN
POOLED ANALYSIS
SURGERY
IORT
CHEMORADIOTHERAPY
CLASSIFICATION
COMPLICATIONS

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Dijkstra, E. A., Mul, V. E. M., Hemmer, P. H. J., Havenga, K., Hospers, G. A. P., Kats-Ugurlu, G., Beukema, J. C., Berveling, M. J., Moumni, M. E., Muijs, C. T., & van Etten, B. (2021). Clinical selection strategy for and evaluation of intra-operative brachytherapy in patients with locally advanced and recurrent rectal cancer. Radiotherapy and Oncology, 159, 91-97. https://doi.org/10.1016/j.radonc.2021.03.010

@article{cdf824f493ba495aacedfb00f49ef47a,

title = "Clinical selection strategy for and evaluation of intra-operative brachytherapy in patients with locally advanced and recurrent rectal cancer",

abstract = "Background and purpose: A radical resection of locally advanced rectal cancer (LARC) or recurrent rectal cancer (RRC) can be challenging. In case of increased risk of an R1 resection, intra-operative brachytherapy (IOBT) can be applied. We evaluated the clinical selection strategy for IOBT.Materials and methods: Between February 2007 and May 2018, 132 LARC/RRC patients who were scheduled for surgery with IOBT standby, were evaluated. By intra-operative inspection of the resection margin and MR imaging, it was determined whether a resection was presumed to be radical. Frozen sections were taken on indication. In case of a suspected R1 resection, IOBT (1 x 10 Gy) was applied. Histopathologic evaluation, treatment and toxicity data were collected from medical records.Results: Tumour was resected in 122 patients. IOBT was given in 42 patients of whom 54.8% (n = 23) had a histopathologically proven R1 resection. Of the 76 IOBT-omitted R0 resected patients, 17.1% (n = 13) had a histopathologically proven R1 resection. In 4 IOBT-omitted patients, a clinical R1/2 resection was seen. In total, correct clinical judgement occurred in 72.6% (n = 88) of patients. In LARC, 58.3% (n = 14) of patients were overtreated (R0, with IOBT) and 10.9% (n = 5) were undertreated (R1, without IOBT). In RRC, 26.5% (n = 9) of patients were undertreated.Conclusion: In total, correct clinical judgement occurred in 72.6% (n = 88). However, in 26.5% (n = 9) RRC patients, IOBT was unjustifiedly omitted. IOBT is accompanied by comparable and acceptable toxicity. Therefore, we recommend IOBT to all RRC patients at risk of an R1 resection as their salvage treatment.(c) 2021 The Author(s). Published by Elsevier B.V. Radiotherapy and Oncology 159 (2021) 91 & ndash;97This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).",

keywords = "Rectal neoplasms, Neoadjuvant therapy, Brachytherapy, Radiation oncology, Patient selection, Adverse effects, CONTAINING MULTIMODALITY TREATMENT, PREOPERATIVE RADIOTHERAPY, RADIATION-THERAPY, RESECTION MARGIN, POOLED ANALYSIS, SURGERY, IORT, CHEMORADIOTHERAPY, CLASSIFICATION, COMPLICATIONS",

author = "Dijkstra, {Esm{\'e}e A} and Mul, {V{\'e}ronique E M} and Hemmer, {Patrick H J} and Klaas Havenga and Hospers, {Geke A P} and Gursah Kats-Ugurlu and Beukema, {Jannet C} and Berveling, {Maaike J} and Moumni, {Mostafa El} and Muijs, {Christina T} and {van Etten}, Boudewijn",

year = "2021",

month = jun,

doi = "10.1016/j.radonc.2021.03.010",

language = "English",

volume = "159",

pages = "91--97",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "ELSEVIER IRELAND LTD",

}

Dijkstra, EA, Mul, VEM, Hemmer, PHJ , Havenga, K , Hospers, GAP , Kats-Ugurlu, G , Beukema, JC , Berveling, MJ , Moumni, ME , Muijs, CT & van Etten, B 2021, 'Clinical selection strategy for and evaluation of intra-operative brachytherapy in patients with locally advanced and recurrent rectal cancer', Radiotherapy and Oncology, vol. 159, pp. 91-97. https://doi.org/10.1016/j.radonc.2021.03.010

TY - JOUR

T1 - Clinical selection strategy for and evaluation of intra-operative brachytherapy in patients with locally advanced and recurrent rectal cancer

AU - Dijkstra, Esmée A

AU - Mul, Véronique E M

AU - Hemmer, Patrick H J

AU - Havenga, Klaas

AU - Hospers, Geke A P

AU - Kats-Ugurlu, Gursah

AU - Beukema, Jannet C

AU - Berveling, Maaike J

AU - Moumni, Mostafa El

AU - Muijs, Christina T

AU - van Etten, Boudewijn

PY - 2021/6

Y1 - 2021/6

N2 - Background and purpose: A radical resection of locally advanced rectal cancer (LARC) or recurrent rectal cancer (RRC) can be challenging. In case of increased risk of an R1 resection, intra-operative brachytherapy (IOBT) can be applied. We evaluated the clinical selection strategy for IOBT.Materials and methods: Between February 2007 and May 2018, 132 LARC/RRC patients who were scheduled for surgery with IOBT standby, were evaluated. By intra-operative inspection of the resection margin and MR imaging, it was determined whether a resection was presumed to be radical. Frozen sections were taken on indication. In case of a suspected R1 resection, IOBT (1 x 10 Gy) was applied. Histopathologic evaluation, treatment and toxicity data were collected from medical records.Results: Tumour was resected in 122 patients. IOBT was given in 42 patients of whom 54.8% (n = 23) had a histopathologically proven R1 resection. Of the 76 IOBT-omitted R0 resected patients, 17.1% (n = 13) had a histopathologically proven R1 resection. In 4 IOBT-omitted patients, a clinical R1/2 resection was seen. In total, correct clinical judgement occurred in 72.6% (n = 88) of patients. In LARC, 58.3% (n = 14) of patients were overtreated (R0, with IOBT) and 10.9% (n = 5) were undertreated (R1, without IOBT). In RRC, 26.5% (n = 9) of patients were undertreated.Conclusion: In total, correct clinical judgement occurred in 72.6% (n = 88). However, in 26.5% (n = 9) RRC patients, IOBT was unjustifiedly omitted. IOBT is accompanied by comparable and acceptable toxicity. Therefore, we recommend IOBT to all RRC patients at risk of an R1 resection as their salvage treatment.(c) 2021 The Author(s). Published by Elsevier B.V. Radiotherapy and Oncology 159 (2021) 91 & ndash;97This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

AB - Background and purpose: A radical resection of locally advanced rectal cancer (LARC) or recurrent rectal cancer (RRC) can be challenging. In case of increased risk of an R1 resection, intra-operative brachytherapy (IOBT) can be applied. We evaluated the clinical selection strategy for IOBT.Materials and methods: Between February 2007 and May 2018, 132 LARC/RRC patients who were scheduled for surgery with IOBT standby, were evaluated. By intra-operative inspection of the resection margin and MR imaging, it was determined whether a resection was presumed to be radical. Frozen sections were taken on indication. In case of a suspected R1 resection, IOBT (1 x 10 Gy) was applied. Histopathologic evaluation, treatment and toxicity data were collected from medical records.Results: Tumour was resected in 122 patients. IOBT was given in 42 patients of whom 54.8% (n = 23) had a histopathologically proven R1 resection. Of the 76 IOBT-omitted R0 resected patients, 17.1% (n = 13) had a histopathologically proven R1 resection. In 4 IOBT-omitted patients, a clinical R1/2 resection was seen. In total, correct clinical judgement occurred in 72.6% (n = 88) of patients. In LARC, 58.3% (n = 14) of patients were overtreated (R0, with IOBT) and 10.9% (n = 5) were undertreated (R1, without IOBT). In RRC, 26.5% (n = 9) of patients were undertreated.Conclusion: In total, correct clinical judgement occurred in 72.6% (n = 88). However, in 26.5% (n = 9) RRC patients, IOBT was unjustifiedly omitted. IOBT is accompanied by comparable and acceptable toxicity. Therefore, we recommend IOBT to all RRC patients at risk of an R1 resection as their salvage treatment.(c) 2021 The Author(s). Published by Elsevier B.V. Radiotherapy and Oncology 159 (2021) 91 & ndash;97This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

KW - Rectal neoplasms

KW - Neoadjuvant therapy

KW - Brachytherapy

KW - Radiation oncology

KW - Patient selection

KW - Adverse effects

KW - CONTAINING MULTIMODALITY TREATMENT

KW - PREOPERATIVE RADIOTHERAPY

KW - RADIATION-THERAPY

KW - RESECTION MARGIN

KW - POOLED ANALYSIS

KW - SURGERY

KW - IORT

KW - CHEMORADIOTHERAPY

KW - CLASSIFICATION

KW - COMPLICATIONS

U2 - 10.1016/j.radonc.2021.03.010

DO - 10.1016/j.radonc.2021.03.010

M3 - Article

C2 - 33741470

SN - 0167-8140

VL - 159

SP - 91

EP - 97

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

ER -

Clinical selection strategy for and evaluation of intra-operative brachytherapy in patients with locally advanced and recurrent rectal cancer

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Keywords

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