Abstract：Objective To explore the clinical efficacy and adverse reactions of the combination of external beam radiotherapy followed by three-dimensional intracavitary brachytherapy in patients with inoperable locally advanced rectal cancer. Methods Clinical data of 11 patients with inoperable locally advanced rectal cancer, 7 male and 4 female, admitted to China-Japan Union Hospital of Jilin University from 2013 to 2015 were retrospectively analyzed. All patients received pelvic external irradiation (50 Gy in 25 fractions), followed by a three-dimensional intracavitary brachytherapy boost (15-20 Gy in 3-4 fractions,1 fraction/week). External beam radiotherapy was used to boost the dose to the perirectal lymph nodes (60-66 Gy in 30-33 fractions). All patients received concurrent chemotherapy with Capecitabine during external beam radiotherapy. Efficacy evaluation was performed using the RECIST standard. Survival and local control rates were calculated using the Kaplan-Meier method. Early and late radiotherapy responses were assessed using the RTOG lesion grading criteria. Results The CTV D90% EQD2 Gy of HDR 3D-ICBT among 11 patients was (21.3±1.60) Gy. The complete response (CR) and partial response (PR) rates were 64% and 27%,respectively, yielding an objective response rate (CR+PR) of 91%. With a median follow-up time of 36 months, the 1-,2-,and 3-year overall survival rates were 82%,64% and 46%,respectively. The 1-,2-,3-year disease-free survival rates were 64%,45% and 27%,respectively. The 3-year local control rate was 46%. One patient presented with lung metastases after 8 months, 7 patients experienced grade 1-2 acute intestinal reactions and 5 patients developed grade 1-2 acute bladder reactions, only one patient had grade 2 myelosuppression;long-term grade 1-2 intestinal reactions occurred in 5 patients, and 1 patient had long-term grade 1-2 bladder reaction. All the radiation-induced toxicities were alleviated by medication administration. Conclusions External beam radiotherapy followed by three-dimensional intracavitary brachytherapy can be a safe and effective surrogate in patients with inoperable locally advanced rectal cancer,which yields reliable clinical efficacy and tolerable adverse reactions.
Zhao Zhipeng,Li Dan,Guan Wei et al. Preliminary observation of the results of external irradiation combined with brachytherapy for inoperable locally advanced rectal cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(6): 437-440.
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