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30.03.2017 | Original Research

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

verfasst von: 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, Nilofer S. Azad, Joseph M. Herman, Susan L. Gearhart

Erschienen in: Journal of Radiation Oncology | Ausgabe 3/2017

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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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Titel: Radiographic predictors of response to endoluminal brachytherapy for the treatment of rectal cancer
verfasst von: 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
Nilofer S. Azad
Joseph M. Herman
Susan L. Gearhart
Publikationsdatum: 30.03.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Radiation Oncology / Ausgabe 3/2017
Print ISSN: 1948-7894
Elektronische ISSN: 1948-7908
DOI: https://doi.org/10.1007/s13566-017-0302-y

Springer Medizin

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