|
1
|
Garant A, Magnan S, Devic S, Martin AG, Boutros M, Vasilevsky CA, Ferland S, Bujold A, DesGroseilliers S, Sebajang H, Richard C, Vuong T. Image Guided Adaptive Endorectal Brachytherapy in the Nonoperative Management of Patients With Rectal Cancer. Int J Radiat Oncol Biol Phys 2019; 105:1005-1011. [PMID: 31476417 DOI: 10.1016/j.ijrobp.2019.08.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Organ preservation or nonoperative management of rectal cancer is of growing interest. Image guided adaptive endorectal brachytherapy is a radiation dose escalation modality: we explored its role in elderly patients unfit for surgery and patients refusing surgery. METHODS AND MATERIALS In this registry study, patients with rectal cancer who were ineligible for surgery received 40 Gy in 16 fractions of pelvic external beam radiation therapy. They subsequently received 3 weekly image guided adaptive brachytherapy boosts of 10 Gy to the residual tumor, for a total of 30 Gy in 3 fractions. Complete clinical response (cCR) and local control were the primary endpoints. RESULTS 94 patients were included; the median age was 81.1 years. With a median follow-up of 1.9 years, the proportion of cCR was 86.2%, the tumor regrowth proportion was 13.6%, and the cumulative incidence of local relapse was 2.7% at 1 year and 16.8% at 2 years. When considering responders and nonresponders, the 2-year local control was 71.5%. The overall survival at 2 years was 63.6%. Acute rectal grade 1 to 2 toxicity included all patients: 12.8% of patients had late bleeding requiring iron replacement, blood transfusions, or argon plasma therapy. CONCLUSIONS Results of this registry study, evaluating radiation dose escalation for elderly medically unfit patients with unselected tumors, reveal that a high proportion of patients achieved cCR with a manageable toxicity profile. This technology will likely contribute to the challenging nonoperative management paradigm of rectal cancer.
Collapse
Affiliation(s)
- Aurelie Garant
- Department of Oncology, Division of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada
| | - Sindy Magnan
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Slobodan Devic
- Department of Oncology, Division of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Medical Physics Unit, McGill University, Montreal, QC H4A 3J1, Canada
| | - André-Guy Martin
- Centre hospitalier universitaire de Québec, Université Laval, Department of Radiation Oncology, Quebec City, QC, Canada
| | - Marylise Boutros
- Department of Surgery, Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada
| | - Carol-Ann Vasilevsky
- Department of Surgery, Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada
| | - Stéphanie Ferland
- CISSSO, Hôpital de Gatineau, Department of Radiation Oncology, Gatineau, QC, Canada
| | - Alexis Bujold
- Hôptial Maisonneuve-Rosemont, Université de Montréal, Department of Radiation Oncology, Montreal, QC, Canada
| | | | - Herawaty Sebajang
- Centre hospitalier de l'Université de Montréal, Department of Surgery, Division of Colon and Rectal Surgery, Montreal, QC, Canada
| | - Carole Richard
- Centre hospitalier de l'Université de Montréal, Department of Surgery, Division of Colon and Rectal Surgery, Montreal, QC, Canada
| | - Té Vuong
- Department of Oncology, Division of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada.
| |
Collapse
|
|
2
|
DesGroseilliers S, Fortin M, Lokanathan R, Khoury N, Mutch D. Laparoscopic appendectomy versus open appendectomy: retrospective assessment of 200 patients. Can J Surg 1995; 38:178-82. [PMID: 7728674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To compare laparoscopic appendectomy (LA) with traditional methods as the primary treatment for acute appendicitis. DESIGN A retrospective case series. SETTING A regional, nonuniversity hospital in northwestern Quebec. PATIENTS Two hundred patients with a clinical diagnosis of acute appendicitis: 100 (43 men, 57 women; mean age 27 years) underwent laparoscopic appendectomy and 100 (67 men, 33 women; mean age 21 years) had an open appendectomy (OA). INTERVENTIONS LA or OA. MAIN OUTCOME MEASURES Operating time, rate of conversion to OA, need for analgesia, morbidity and outcome. RESULTS LA was successful in 88% of patients. The mean operating time was 50 minutes for LA versus 24 minutes for OA. On average, patients of the LA group had a 1-day decrease in postoperative hospital stay (2.6 versus 3.6 days). The wound infection rate was lower in the LA group (2% versus 12%) as was the intra-abdominal abscess rate (2% versus 6.0%). There were no deaths in either group. The overall morbidity was 4.5% for the LA group and 18% for the OA group. A clear tendency toward a shorter convalescence was seen in the LA group. CONCLUSIONS LA is a safe and viable treatment alternative for acute appendicitis. Prospective randomized studies are needed to confirm its potential advantages.
Collapse
|