Citation: Brachytherapy. 2019, 18(3)
Author: Stewart A.J.; Myint A.S.
Abstract: Purpose: The use of rectal brachytherapy is increasing. Two forms of rectal brachytherapy are available; contact brachytherapy using low energy X-Rays (CXB)and high dose rate brachytherapy (HDR-B). The use of a contact brachytherapy boost has been shown in medically inoperable patients to Result in a significantly lower rate of colostomy formation. In the UK approval has been granted by the National Institute of Clinical Excellence (NICE)for its use for primary rectal cancer control, particularly in elderly patients. In Europe, a randomized trial is recruiting comparing contact brachytherapy with an external beam radiotherapy boost. Phase two results of HDR-B in the pre-operative setting in place of external beam radiotherapy to the pelvis show low rates of locoregional
recurrence and a phase 3 study in North America is currently examining this in a randomized setting. The use of HDR-B in the palliative setting in surgically inoperable patients is also increasing and it appears to provide good palliation with acceptable rates of toxicity. Material(s) and Method(s): A multi-disciplinary group of ESTRO and ABS members was convened to develop consensus guidelines based on randomized trial data and clinical experience. Since there was greater variation in practice for HDR-B than CXB, an international survey was circulated regarding current practice and future expectations for clinical and dosimetry standards and reporting for HDR-B. Result(s): The GEC ESTRO/ABS consensus guidelines recommend the use of CXB for patients who are elderly
or surgically unfit or in selected patients with early stage low rectal tumours who wish to avoid colostomy formation. For palliative treatment, the use of HDR-B is recommended for symptomatic relief and disease control in surgically unfit or inoperable patients or those in whom radiotherapy is preferred to surgery. The use of rectal HDR-B is recommended within the setting of a clinical trial or registry for preoperative treatment or in an organ-preservation setting in surgically fit patients. HDR-B for palliation is recommended and dose fractionation schemes are given with recommendations for dosimetry and reporting in both the routine and the research setting.
Conclusion(s): The GEC ESTRO/ABS recommendations for rectal brachytherapy have been developed. Practitioners are encouraged to follow these guidelines and to develop further clinical trials to examine this treatment modality and increase the evidence base for its use. The routine collection of outcomes both clinical and patient-reported is also encouraged.
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