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Engineer R, Datta D, Gudi S, Krishnatry R, deSouza A, Ankathi SK, Kohle S, Saklani A. Dose Escalation Using Magnetic Resonance Guided High-Dose-Rate Endorectal Brachytherapy to Enhance Clinical Response after Neoadjuvant Radiotherapy in Rectal Adenocarcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e295. [PMID: 37785083 DOI: 10.1016/j.ijrobp.2023.06.2304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To assess the proportion of patients with rectal adenocarcinoma achieving clinical complete response after neoadjuvant chemoradiation (NACTRT) and MR guided endorectal brachytherapy boost (MR-ERBT) MATERIALS/METHODS: Patients with rectal cancers (T2-T4/N0-N+) treated with concurrent chemoradiotherapy (50Gy/25# with Capecitabine) between June-2017 to April-2022. Post RT, patients having residual non-circumferential lesions <8cm in length were administered escalated-dose MR-ERBT with Ir192 HDR source. A median dose of 12Gy (8-15Gy) in 3 (2-3) fractions at 3-5 day intervals was delivered using MR-ERBT after external radiation. Data on near complete/complete clinical response (nCR/cCR) rates, local regrowth rates and clinical outcome were collected for analysis. RESULTS Of the 145 patients who received MR-ERBT, majority were staged as T3(78.7%) and N1-2 (77.5%) rectal cancers. Median tumor length was 4cm and 123 (85%) of the tumors were located in the lower rectum (0-5cm from anal verge). Seventy-six (52%) patients achieved cCR or nCR (37 cCR, 39 nCR) and were advised observation or watch and wait (WW) management. The 69 patients having partial response were advised surgery. The patients having nCR 16 (29%) underwent resection, of these 10 (62%) had pathological complete response (pCR). The patients with partial or poor response, 57 underwent resection and of these 11 (19%) had pCR, 12 patients refused surgery due to fear of permanent stoma and continued to be on follow up. Of the 79 patients undergoing resection, 36 (45.5%) had sphincter preserving surgeries. At the median follow up of 30 months, local regrowth was seen in 8 (10.5%) of patients on WW and 6 were surgically salvaged while other 2 had synchronous metastatic relapse. Thus, 56 (41%) achieved organ preservation and continued to be on WW management. Twelve (8,2%) patients developed distant metastasis in the entire cohort, 3 in the WW group and 9 in the resected group. There were no pelvic recurrences seen in the resected patients. The disease-free survival at 3 years were (96.1% vs 89% Observation vs. resected (p_0.05) respectively. The overall survival at 3 years were (93% vs 98% Observation vs. resected (p_0.44) respectively. Late rectal toxicity was observed in 16(11%) patients on observation CONCLUSION: Dose Escalated MR-EBRT is an effective and safe method to enhance complete clinical response, thus improving the rate of organ preservation for distal rectal cancers.
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Affiliation(s)
- R Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - D Datta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Gudi
- Tata Memorial Centre, Mumbai, India
| | - R Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A deSouza
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S K Ankathi
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Kohle
- Tata Memorial Centre, Mumbai, Maharashtra, India
| | - A Saklani
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Engineer R, Datta D, Saklani A, deSouza A, Baheti A, Ankathi S, Krishnatry R, Gudi S, Patil P. Reduction of Tumor Length by >50%, Post Neoadjuvant Chemoradiation as a Predictor for Complete Response and Organ Preservation in Rectal Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Raj Kumar B, Bankar S, Pandey D, Rohila J, Prakash G, Bakshi G, deSouza A, Saklani A. Abdominoperineal excision with prostatectomy in T4 rectal cancer - bladder-sparing robotic pelvic exenteration - a video vignette. Colorectal Dis 2020; 22:1786-1787. [PMID: 32548955 DOI: 10.1111/codi.15200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/30/2020] [Indexed: 02/08/2023]
Affiliation(s)
- B Raj Kumar
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Bankar
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - D Pandey
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J Rohila
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Prakash
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Bakshi
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A deSouza
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Saklani
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Kumar S, Rohila J, Sasi SP, Tantravahi U, K G D, Sharma V, Garach N, deSouza A, Saklani A. Robotic-assisted low anterior resection: beyond total mesorectal excision; a left vascular approach with presacral fascia excision - a video vignette. Colorectal Dis 2020; 22:595-596. [PMID: 31901001 DOI: 10.1111/codi.14947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023]
Affiliation(s)
- S Kumar
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - J Rohila
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - S P Sasi
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - U Tantravahi
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - Dharmakumar K G
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - V Sharma
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - N Garach
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - A deSouza
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
| | - A Saklani
- Colorectal Division, GI services, Tata Memorial Centre, HBNI University, Mumbai, India
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Rohila J, Singh P, Sasi SP, Kumar S, deSouza A, Saklani A. Laparoscopic posterior supralevator exenteration for locally advanced rectal cancer with incisional hernia repair - a video vignette. Colorectal Dis 2020; 22:351. [PMID: 31654449 DOI: 10.1111/codi.14889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/30/2019] [Indexed: 02/08/2023]
Affiliation(s)
- J Rohila
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
| | - P Singh
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
| | - S P Sasi
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
| | - S Kumar
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
| | - A deSouza
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
| | - A Saklani
- Colorectal Division, GI Services, Tata Memorial Center, Homi Bhaba National University (HBNI), Mumbai, India
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Kammar P, Sasi S, Kumar N, Rohila J, deSouza A, Saklani A. Robotic posterior pelvic exenteration for locally advanced rectal cancer - a video vignette. Colorectal Dis 2019; 21:606. [PMID: 30856286 DOI: 10.1111/codi.14606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/05/2018] [Indexed: 02/08/2023]
Affiliation(s)
- P Kammar
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - S Sasi
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - N Kumar
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - J Rohila
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - A deSouza
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
| | - A Saklani
- Colorectal Division, GI services, Tata Memorial Center, Mumbai, India
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