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Radiographic predictors of response to endoluminal brachytherapy for the treatment of rectal cancer

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

Endoluminal brachytherapy (EBT) has been shown to be an effective neoadjuvant monotherapy for rectal adenocarcinoma. Radiographic predictors of response are used to guide treatment in rectal cancer; however, no predictors of response to EBT have been identified.

Methods

This is a single-institutional prospective study from 2010 to 2013. Analysis included 17 patients undergoing EBT and 13 patients undergoing conventional external beam chemoradiation (CRT). Clinical response to therapy was assessed with serial MRI and PET/CT variables. Pathological response to therapy was assessed using tumor regression grade (TRG) and compared with clinical response.

Results

EBT and CRT patients did not differ with respect to age, sex, race, carcinoembryonic antigen, or clinical stage of disease. There was a similar rate of pathologic complete response for both groups, with a trend towards more TRG 0 with EBT compared with CRT (35.3% vs. 7.7%, p = 0.08). Four days of EBT resulted in a significantly greater reduction in tumor volume on MRI than did CRT (92.7% vs. 63.1%, p = 0.004). Using receiver operating characteristic analysis, change in peak standardized uptake value was the best predictor for complete pathologic response in EBT patients (sensitivity 67%, specificity 82%). False-positive findings for nodal disease on MRI were seen in 59% of EBT patients and 23% of CRT patients.

Conclusions

This study demonstrates that EBT is an effective alternative with similar response rates to CRT. However, the inability of MRI and PET/CT to discern reactive from malignant tumor and nodes may pose limitations in their use for guiding further therapy. Larger randomized studies are needed.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA

    Rebecca Craig-Schapiro, Caitlin W. Hicks, Jonathan E. Efron, Elizabeth C. Wick & Susan L. Gearhart

  2. Department of Radiology, Johns Hopkins University, Baltimore, MD, USA

    Ihab R. Kamel & Michael Sacerdote

  3. Center for Surgical Trials and Outcomes Research, Johns Hopkins University, Baltimore, MD, USA

    Joseph Canner

  4. Department of Pathology, Johns Hopkins University, Baltimore, MD, USA

    Meredith Pittman

  5. Department of Medical Oncology, Johns Hopkins University, Baltimore, MD, USA

    Amy Hacker-Prietz, Nilofer S. Azad & Joseph M. Herman

  6. Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA

    Robert F. Hobbs, Elwood P. Armour & Joseph M. Herman

Authors
  1. Rebecca Craig-Schapiro
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  2. Ihab R. Kamel
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  14. Susan L. Gearhart
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Corresponding author

Correspondence to Susan L. Gearhart.

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Funding

This work was supported by the Elekta/Nucletron company who provided study support; however, no salary support was provided for the investigators.

Conflict of interest

Rebecca Craig-Schapiro, Ihab R. Kamel, Michael Sacerdote, Joseph Canner, Meredith Pittman, Caitlin W. Hicks, Amy Hacker-Prietz, Robert F. Hobbs, Elwood P. Armour, Jonathan E. Efron, Elizabeth C. Wick, and Nilofer S. Azad, declare that they have no conflict of interest. Joseph M. Herman and Susan L. Gearhart were investigators on a grant with Elekta/Nucletron who supplied financial support for the study; however, no salary support was given for this study.

Ethical approval

This study was approved by the institutional review board of Johns Hopkins, and written informed consent was obtained from all study participants. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.

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Craig-Schapiro, R., Kamel, I.R., Sacerdote, M. et al. Radiographic predictors of response to endoluminal brachytherapy for the treatment of rectal cancer. J Radiat Oncol 6, 287–294 (2017). https://doi.org/10.1007/s13566-017-0302-y

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  • DOI: https://doi.org/10.1007/s13566-017-0302-y

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