Advances in research on endorectal brachytherapy for aged patients with distal rectal carcinoma
10.3760/cma.j.cn112271-20231204-00193
- VernacularTitle:直肠癌内照射在低位和老年患者中的应用进展
- Author:
Bo YAO
1
;
Yaowei ZHAO
;
Zhilei ZHAO
;
Zhiqiang MA
Author Information
1. 北京美中爱瑞肿瘤医院放疗科，北京 102613
- Keywords:
Distal rectal carcinoma;
Endorectal brachytherapy;
Radiotherapy;
Organ preservation;
Nonsurgical
- From:
Chinese Journal of Radiological Medicine and Protection
2024;44(9):797-802
- CountryChina
- Language:Chinese
-
Abstract:
The preservation of anal sphincter function is an urgent demand for patients with distal rectal carcinoma who expect a good quality of life, especially for aged patients intolerant to surgery due to their poor physical conditions, always posing clinical challenges. Although the clinical complete response (cCR) rates of 24%-49% achieved by neoadjuvant chemoradiotherapy or total neoadjuvant therapy (TNT) allow partial patients to avoid or delay anal resection by adopting a wait-and-see strategy, they still face the risk of local recurrence. Studies have confirmed a dose-response relationship in radiotherapy for rectal cancer, with local doses ranging from 72 to 92 Gy potentially achieving a cCR rate of 50%. In contrast, the tolerated doses for conventional external beam radiotherapy (EBRT) vary between 45 and 54 Gy, while higher doses may cause severe damage to normal organs or tissues. Endorectal brachytherapy, characterized by direct irradiation of tumors, a short irradiation range, and rapid dose fall-off, increases local exposure dose while protecting surrounding organs and even the contralateral normal rectal mucosa. Two main modalities of endorectal brachytherapy are available: 50 kV contact X-ray therapy (CXB) and high-dose-rate brachytherapy (HDR-BT). This review summarizes and analyzes the latest advances in research on endorectal brachytherapy, demonstrating its association with higher cCR rates, long-term local control rates, and lower adverse reaction rates. Therefore, endorectal brachytherapy is a more beneficial alternative for aged patients with distal rectal carcinoma who are intolerant to surgery due to their poor physical conditions and require anal sphincter preservation.
