CT-based adaptive high-dose-rate endorectal brachytherapy in the preoperative treatment of locally advanced rectal cancer: Technical and practical aspects

Abstract Purpose During the last decade due to the availability of a CT scan in the brachytherapy suite, high-dose-rate endorectal brachytherapy (HDREBT) has evolved as a CT-based daily adaptive treatment. An update of the technical and practical aspects of HDREBT is provided. Methods and Materials...

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Bibliographic Details
Published inBrachytherapy Vol. 15; no. 4; pp. 477 - 484
Main Authors Nout, R.A, Devic, S, Niazi, T, Wyse, J, Boutros, M, Pelsser, V, Vuong, T
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.07.2016
Subjects
Adaptive radiotherapy
Brachytherapy
Brachytherapy - methods
Digestive System Surgical Procedures
Hematology, Oncology and Palliative Medicine
Humans
Neoadjuvant Therapy
Preoperative radiotherapy
Radiology
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted - methods
Rectal cancer
Rectal Neoplasms - pathology
Rectal Neoplasms - radiotherapy
Sigmoidoscopy
Tomography, X-Ray Computed - methods
Treatment Outcome
Preoperative radiotherapy
Brachytherapy
Rectal cancer
Adaptive radiotherapy
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Summary:Abstract Purpose During the last decade due to the availability of a CT scan in the brachytherapy suite, high-dose-rate endorectal brachytherapy (HDREBT) has evolved as a CT-based daily adaptive treatment. An update of the technical and practical aspects of HDREBT is provided. Methods and Materials Description of technical and practical aspects of HDREBT focused on the preoperative treatment of locally advanced rectal cancer. During preoperative HDREBT, 26 Gy is delivered in four daily applications of 6.5 Gy prescribed to the 100% isodose, covering the clinical target volume. Daily CT scans are obtained and used for plan optimization, leaving patient positioning unchanged between CT scan and treatment delivery. Results All steps of HDREBT treatment procedure are discussed in detail: flexible proctosigmoidoscopy and clipping; patient setup; applicator placement; target delineation; treatment planning and delivery; and patient care. Afterward, treatment results are reviewed. Conclusions CT-based adaptive preoperative HDREBT is a practical and feasible therapy for locally advanced rectal cancer, offering excellent local control with a favorable toxicity profile.
ISSN:1538-4721
1873-1449
DOI:10.1016/j.brachy.2016.03.004