543P - Organ preservation using contact radiotherapy for early rectal cancer: outcomes of patients treated at a single centre in the United Kingdom

Date 08 October 2016
Event ESMO 2016 Congress
Session Poster Display
Topics Surgical oncology
Colon and Rectal Cancer
Therapy
Radiation oncology
Presenter Amandeep Dhadda
Citation Annals of Oncology (2016) 27 (6): 149-206. 10.1093/annonc/mdw370
Authors A.S. Dhadda1, A. Martin1, G. Solon2, I.A. Hunter2
  • 1Castle Hill Hospital, Queen's Centre for Oncology & Haematology, HU16 5JQ - Kingston upon Hull/GB
  • 2Colorectal Surgery, Castle Hill Hospital, HU16 5JQ - Kingston upon Hull/GB

Abstract

Background

Contact radiotherapy for early rectal cancer utilises 50KV x-rays to treat rectal cancers under direct vision as described by Papillon (1). We present data of a series of patients treated in a modern era at our centre in Hull, England, UK with prospective follow up.

Methods

All patients were treated at the Queen's Centre for Oncology, Hull, United Kingdom between September 2011 and September 2015. Patients were worked up with biopsy, MRI of liver and pelvis, CT Chest and endorectal US. Indications for contact radiotherapy are shown in table 1. Patients were offered either 110Gy in 4 fractions to the luminal tumour or 90Gy in 3 fractions with external beam chemo/radiotherapy to the pelvis dependent on the risk of mesorectal lymphadenopathy. Follow up consisted of 3 monthly flexible sigmoidoscopy and MRI liver/pelvis and 12 monthly CT Chest. Median follow-up was 24 months (range 1-54 months).

Results

Between September 2011 and September 2015 a total of 43 patients were treated with contact radiotherapy without any surgical excision. Demographics of patients are shown in table 2. Median age was 78 years (range 50-94 years). 24 patients (57%) were considered high risk for surgery. Mortality from the contact radiotherapy procedure was 0%. Functional outcomes as investigated by the Lower Anterior Resection Syndrome (LARS) score were good with 68% having no LARS and 30 % a major LARS (2). There were 5 local recurrences (12%) of which 2 received successful surgical salvage. Distant recurrences were found in 4 patients (9%). Median time to recurrence was 12 months (range 3-14 months). Disease free and overall survival curves are shown in figs 1 and 2. Local recurrence free survival was 88%, disease free survival 86% and overall survival 88% with a median follow up of 24 months. Estimated 30 day surgical mortality for this cohort with radical surgery was 12% (3).

Conclusions

Contact radiotherapy for early rectal cancer is a safe, well tolerated outpatient procedure allowing organ preservation with excellent early results on oncological and functional outcomes from our centre. For elderly patients with co-morbidities and suitable rectal cancers this should be considered a standard of care.

Clinical trial identification

Legal entity responsible for the study

Hull & East Yorkshire NHS Trust

Funding

Hull & East Yorkshire NHS Trust

Disclosure

All authors have declared no conflicts of interest.