title: Organ Preservation Using Contact Radiotherapy for Early Rectal Cancer: Outcomes of Patients Treated at a Single Centre in the UK.
abstract: OBJECTIVE
  Contact radiotherapy for early rectal cancer uses 50 kV X-rays to treat rectal cancers under direct vision. We present data of a series of patients treated at a single centre with prospective follow-up and functional assessment.
  
  
  METHODS
  All patients were treated at the Queen's Centre for Oncology, Hull, UK between September 2011 and October 2015. Patients received a biopsy, magnetic resonance imaging (MRI) of the liver/pelvis, computed tomography of the chest and endorectal ultrasound. Patients were deemed to be either unfit for radical surgery or refused it due to the need for a permanent stoma. Follow-up consisted of 3 monthly flexible sigmoidoscopy and MRI of the liver/pelvis and 12 monthly computed tomography of the chest.
  
  
  RESULTS
  In total, 42 patients were treated with contact radiotherapy ± external beam chemo/radiotherapy without any primary surgical excision. The median age was 78 years (range 50-94 years). Local recurrence-free survival was 88%, disease-free survival was 86% and overall survival was 88% with a median follow-up of 24 months (range 5-54 months). The median time to recurrence was 12 months (range 4-14 months). The estimated 30 day surgical mortality for this cohort with radical surgery was 12%. Mortality from the contact radiotherapy procedure was 0%. Functional outcomes as investigated by the Low Anterior Resection Syndrome (LARS) score were good, with 65% having no LARS.
  
  
  CONCLUSIONS
  Contact radiotherapy for early rectal cancer is a safe, well-tolerated outpatient procedure, allowing organ preservation, with excellent oncological and functional outcomes. For elderly co-morbid patients with suitable rectal cancers this should be considered as a standard of care.
authors.affiliation: Queen's Centre for Oncology & Haematology, Castle Hill Hospital, Hull, UK. Electronic address: Amandeep.Dhadda@hey.nhs.uk.
authors.forename: A S
authors.initials: AS
authors.lastname: Dhadda
authors.affiliation: Queen's Centre for Oncology & Haematology, Castle Hill Hospital, Hull, UK.
authors.forename: A
authors.initials: A
authors.lastname: Martin
authors.affiliation: Queen's Centre for Oncology & Haematology, Castle Hill Hospital, Hull, UK.
authors.forename: S
authors.initials: S
authors.lastname: Killeen
authors.affiliation: Queen's Centre for Oncology & Haematology, Castle Hill Hospital, Hull, UK.
authors.forename: I A
authors.initials: IA
authors.lastname: Hunter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011878:Radiotherapy / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Organ preservation; radiotherapy; rectal cancer