Advertisement

What Is the Contribution of Brachytherapy in Tailoring Local Therapy?

  • Jean-Pierre Gérard
  • Te Vuong
  • Jean-Michel Hannoun-Lévi
  • Arthur Sun Myint
Chapter

Abstract

Brachytherapy is a generic term to describe radionuclide “curietherapy,” usually performed with iridium 192 or contact X-ray 50 kV (CXRT) to deliver radiation dose with a short (brachy) FSD (focus skin distance) of 6 cm or less for rectal cancer. Iridium 192 can be used either with an endoluminal approach or with an interstitial perineal implant. CXRT is delivered through a rigid proctoscope under direct control of the vision. The advantage of brachytherapy is an excellent geographical accuracy delivering a very high dose into a small volume. The result is a high rate of tumor response with little toxicity, allowing hypofractionation. In an era of treatment tailoring for rectal cancer, brachytherapy should play an increasing role mainly to improve the chances of conservative treatment. In operable patient, it can be used to cure T1N0 either after local excision or with irradiation alone. In T2N0 in combination with external beam radiotherapy (± chemotherapy), it can be used for organ preservation within the frame of clinical prospective trial. In inoperable frail patients, brachytherapy should play a major role to cure early rectal tumors or to palliate more advanced lesions.

Keywords

Rectal Cancer Local Excision Inoperable Patient Malignant Polyp Percentage Depth Dose 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

Jean-Pierre GERARD is the medical advisor of the Ariane Medical systems company (UK).

References

  1. 1.
    Aumock A, Birnbaum EH, Fleshman JW et al (2001) Treatment of rectal adenocarcinoma with endocavitary and external beam radiotherapy: results for 199 patients with localized tumors. Int J Radiat Oncol Biol Phys 51(2):363–370PubMedCrossRefGoogle Scholar
  2. 2.
    Gérard JP, Chapet O, Romestaing P et al (2000) Local excision and adjuvant radiotherapy for rectal adenocarcinoma T1–2N0. Gastroenterol Clin Biol 24(4):430–435PubMedGoogle Scholar
  3. 3.
    Gerard JP, Romestaing P, Chapet O (2003) Radio­therapy alone in the curative treatment of rectal carcinoma. Lancet Oncol 4(3):158–166PubMedCrossRefGoogle Scholar
  4. 4.
    Gerard JP, Chapet O, Nemoz C et al (2004) Improved sphincter preservation in low rectal cancer with ­high-dose preoperative radiotherapy: the lyon R96–02 randomized trial. J Clin Oncol 22(12):2404–2409PubMedCrossRefGoogle Scholar
  5. 5.
    Goes RN, Beart RW Jr, Simons AJ et al (1997) Use of brachytherapy in management of locally recurrent rectal cancer. Dis Colon Rectum 40:1177–1179PubMedCrossRefGoogle Scholar
  6. 6.
    Jakobsen A, Mortensen JP, Bisgaard C et al (2006) Preoperative chemoradiation of locally advanced T3 rectal cancer combined with an endorectal boost. Int J Radiat Oncol Biol Phys 64(2):461–465PubMedCrossRefGoogle Scholar
  7. 7.
    Lindegaard J, Gerard JP, Sun Myint A et al (2007) Whither papillon? Future directions for contact radiotherapy in rectal cancer. Clin Oncol (R Coll Radiol) 19(9):738–741CrossRefGoogle Scholar
  8. 8.
    Papillon J (1975) Intracavitary irradiation of early rectal cancer for cure. A series of 186 cases. Cancer 36(2):696–701PubMedCrossRefGoogle Scholar
  9. 9.
    Papillon J, Montbarbon JF, Gerard JP et al (1989) Interstitial curietherapy in the conservative treatment of anal and rectal cancers. Int J Radiat Oncol Biol Phys 17(6):1161–1169PubMedCrossRefGoogle Scholar
  10. 10.
    Sun Myint A, Grieve RJ, McDonald AC (2007) Combined modality treatment of early rectal cancer: the UK experience. Clin Oncol (R Coll Radiol) 19(9):674–681CrossRefGoogle Scholar
  11. 11.
    Sun Myint A, Mukhopadhyay T, Ramani VS et al (2010) Can increasing the dose of radiation by HDR brachytherapy boost following preoperative chemoradiotherapy for advanced rectal cancer improve surgical outcome. Colorectal Dis 12(suppl 2):30–36PubMedCrossRefGoogle Scholar
  12. 12.
    Vuong T, Richard C, Niazi T (2010) High dose rate endorectal brachytherapy for curable rectal cancer. Semin Colon Rectal Surg 21:115–119CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Jean-Pierre Gérard
    • 1
    • 2
  • Te Vuong
    • 3
  • Jean-Michel Hannoun-Lévi
    • 1
    • 2
  • Arthur Sun Myint
    • 4
  1. 1.Department of OncologyAntoine Lacassagne Cancer CenterNice Cedex 2France
  2. 2.Université de Nice, UNSANice Cedex 2France
  3. 3.Department of Radiation OncologyJewish General Hospital, McGill UniversityMontrealCanada
  4. 4.Department of Radiation OncologyClatterbridge Centre for OncologyWirralUK

Personalised recommendations