PD-0019 - Organ preservation using contact radiotherapy for early rectal cancer: outcomes of patients treated at a single centre in the United Kingdom

Date 27 June 2014
Event World GI 2014
Session Poster discussion session IV - Miscellaneous
Topics Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Amandeep Dhadda
Citation Annals of Oncology (2014) 25 (suppl_2): ii5-ii13. 10.1093/annonc/mdu164
Authors A. Dhadda1, J. Cast2, I. Hunter2
  • 1Queen's Centre for Oncology & Haematology, Hull/UK
  • 2Castle Hill Hospital, Hull/UK

Abstract

Introduction

Contact radiotherapy for early rectal cancer utilises 50KV x-rays to treat rectal cancers under direct vision as described by Papillon. We present data of a series of patients treated at our centre in Hull, England, UK.

Methods

The contact radiotherapy service for early rectal cancer at the Queen's Centre for Oncology, Hull, United Kingdom commenced in September 2011. Patients were initially discussed at a multi-disciplinary meeting and were worked up with initial biopsy, MRI of liver and pelvis, CT Chest and endorectal US. Indications for contact radiotherapy are shown in table 1. All patients were treated using the Arianne Papillon50 machine. Patients treated following a local transanal excision were offered 60Gy in 2 fractions +/- external beam chemo/radiotherapy to the pelvis to treat potential mesorectal nodes. Patients treated with primary radiotherapy were offered 90Gy in 3 fractions +/- external beam chemo/radiotherapy to the pelvis. Pelvic radiotherapy volumes conformed to that described in the ARISTOTLE trial protocol. Follow up consisted of 3 monthly flexible sigmoidoscopy and 6 monthly MRI liver/pelvis and CT Chest. Median follow-up was 12 months (range 1-29 months).

Results

Between September 2011 and January 2014 a total of 42 patients were treated. Demographics of patients are shown in table 2. Median age was 78 years (range 50-94 years). 5 patients (12%) were treated with palliative intent with median survival in this group exceeding 12 months. In total 37 patients (88%) were treated radically for cure of which 12 had a local excision prior to treatment. 16 patients were high risk for radical resection due to co-morbidities with 21 patients refusing radical surgery due to the need for a permanent stoma. Mortality from the contact radiotherapy procedure was 0%. Morbidity generally consisted of grade 2 rectal bleeding in 5%, urgency/frequency of defaecation in 11%.

There were a total of 2 local recurrences in the radically treated patients (5%). Distant recurrences were found in 3 patients (8%). Median time to recurrence was 6 months (range 2-19 months). Disease free survival curves for radically treated patients are shown in fig 1.

Conclusion

Contact radiotherapy for early rectal cancer is a safe, well tolerated outpatient procedure allowing organ preservation with promising initial results on outcomes from our centre.