GEC ESTRO ACROP consensus recommendations for contact brachytherapy for rectal cancer

Alexandra J Stewart; Evert J Van Limbergen; Jean-Pierre Gerard; Ane L Appelt; Frank Verhaegen; Maaike Berbee; Te Vuong; Ciarna Brooker; Tim Rockall; Arthur Sun Myint

doi:10.1016/j.ctro.2021.12.004

GEC ESTRO ACROP consensus recommendations for contact brachytherapy for rectal cancer

Clin Transl Radiat Oncol. 2021 Dec 11:33:15-22. doi: 10.1016/j.ctro.2021.12.004. eCollection 2022 Mar.

Authors

Alexandra J Stewart^{1

2}, Evert J Van Limbergen³, Jean-Pierre Gerard⁴, Ane L Appelt⁵, Frank Verhaegen³, Maaike Berbee³, Te Vuong⁶, Ciarna Brooker¹, Tim Rockall^{1

2}, Arthur Sun Myint^{7

8}

Affiliations

¹ St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, England, United Kingdom.
² University of Surrey, Guildford, England, United Kingdom.
³ Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
⁴ Centre Antoine LACASSAGNE, Nice, France.
⁵ Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom.
⁶ Dept. of Radiation Oncology, Jewish General Hospital, Montreal, Canada.
⁷ Clatterbridge Cancer Centre, Liverpool, England, United Kingdom.
⁸ University of Liverpool, Liverpool, England, United Kingdom.

Abstract

Purpose: To issue consensus recommendations for contact X-Ray brachytherapy (CXB) for rectal cancer covering pre-treatment evaluation, treatment, dosimetric issues and follow-up. These recommendations cover CXB in the definitive and palliative setting.

Methods: Members of GEC ESTRO with expertise in rectal CXB issued consensus-based recommendations for CXB based on literature review and clinical experience. Levels of evidence according to the Oxford Centre for Evidence based medicine guidance are presented where possible.

Results: The GEC ESTRO ACROP consensus recommendations support the use of CXB to increase the chances of clinical complete remission and cure for patients who are elderly with high surgical risk, surgically unfit or refusing surgery. For palliative treatment, the use of CXB is recommended for symptomatic relief and disease control. The use of CXB in an organ-preservation setting in surgically fit patients is recommended within the setting of a clinical trial or registry.

Conclusions: The GEC ESTRO ACROP recommendations for CXB are provided. Recommendations towards standardisation of reporting and prescription are given. Practitioners are encouraged to follow these recommendations 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.

Keywords: ACROP, Advisory Committee for Radiation Oncology Practice; CTV, Clinical target volume; CXB, Contact X-ray brachytherapy; Consensus recommendations; Contact X-Ray brachytherapy; EBRT, External beam radiotherapy; GEC ESTRO, Groupe Européen de CuriethérapieEuropean Society for Radiotherapy and Oncology; GTN, Glyceryl-trinitrate; GTV, Gross tumour volume; MRI, Magnetic resonance imaging; NTCP, Normal tissue complication probability; PTV, Planning target volume; Papillon treatment; Rectal cancer; TEMS, Transanal endoscopic microsurgery; TME, Total mesorectal excision; US, Ultrasound; cCR, complete clinical response; kV, Kilovoltage.