title: CT-based adaptive high-dose-rate endorectal brachytherapy in the preoperative treatment of locally advanced rectal cancer: Technical and practical aspects.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Nout
authors.affiliation: Department of Radiation Oncology, Jewish General Hospital, McGill University, Montréal, Québec, Canada; Medical Physics Unit, McGill University, Montréal, Québec, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Devic
authors.affiliation: Department of Radiation Oncology, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Niazi
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Wyse
authors.affiliation: Department of Surgery, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Boutros
authors.affiliation: Department of Radiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Pelsser
authors.affiliation: Department of Radiation Oncology, Jewish General Hospital, McGill University, Montréal, Québec, Canada. Electronic address: tvuong@jgh.mcgill.ca.
authors.forename: T
authors.initials: T
authors.lastname: Vuong
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D013505:Digestive System Surgical Procedures; D006801:Humans; D020360:Neoadjuvant Therapy; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D012812:Sigmoidoscopy; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Adaptive radiotherapy; Brachytherapy; Preoperative radiotherapy; Rectal cancer