title: High-dose-rate intraluminal brachytherapy during preoperative chemoradiation for locally advanced rectal cancers.
abstract: OBJECTIVE
  To determine the feasibility and safety of high dose rate intraluminal brachytherapy (HDR-ILBT) boost during preoperative chemoradiation for rectal cancer.
  
  
  METHODS
  Between 2008 and 2009, thirty-six patients with locally advanced rectal cancer (≥ T3 or N+), were treated initially with concurrent capecitabine (825 mg/m(2) oral twice daily) and pelvic external beam radiotherapy (EBRT) (45 Gy in 25 fractions), then were randomized to group A; HDR-ILBT group (n = 17) to receive 5.5-7 Gy × 2 to gross tumor volume (GTV) and group B; EBRT group (n = 19) to receive 5.4 Gy × 3 fractions to GTV with EBRT. All patients underwent total mesorectal excision.
  
  
  RESULTS
  Grade 3 acute toxicities were registered in 12 patients (70.6%) in group A and in 8 (42.1%) in group B. Complete pathologic response of T stage (ypT0) in group A was registered in 10 patients (58.8%) and in group B, 3 patients (15.8%) had ypT0 (P < 0.0001). Sphincter preservation was reported in 6/9 patients (66.7%) in group A and in 5/10 patients (50%) in group B (P < 0.01). Overall radiological response was 68.15% and 66.04% in Group A and B, respectively. During a median follow up of 18 mo, late grade 1 and 2 sequelae were registered in 3 patients (17.6%) and 4 patients (21.1%) in the groups A and B, respectively.
  
  
  CONCLUSIONS
  HDR-ILBT was found to be effective dose escalation technique in preoperative chemoradiation for rectal cancers, with higher response rates, downstaging and with manageable acute toxicities.
authors.affiliation: Department of Radiation Oncology, Sindh Institute of Urology and Transplantation, 74200-Karachi, Pakistan. drmutahirtonio@hotmail.com
authors.forename: Mutahir Ali
authors.initials: MA
authors.lastname: Tunio
authors.forename: Mansoor
authors.initials: M
authors.lastname: Rafi
authors.forename: Altaf
authors.initials: A
authors.lastname: Hashmi
authors.forename: Rehan
authors.initials: R
authors.lastname: Mohsin
authors.forename: Abdul
authors.initials: A
authors.lastname: Qayyum
authors.forename: Mujahid
authors.initials: M
authors.lastname: Hasan
authors.forename: Amjad
authors.initials: A
authors.lastname: Sattar
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mubarak
mesh_terms: D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods*; D000069287:Capecitabine; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil