Cancer Center, Peking University 3rd Hospital, Beijing, China.
Peking University Health Science Center, Peking University, Beijing, China.
Cancer Sci. 2023 Nov;114(11):4145-4156. doi: 10.1111/cas.15959. Epub 2023 Sep 13.
Rectal cancer is a common malignancy that requires multidisciplinary treatment. By utilizing the dose-response relationship in rectal cancer radiotherapy, increasing the radiotherapy dose can improve clinical complete remission rates. High-dose rate endorectal brachytherapy (HDREBT) is a novel technique that delivers high doses of radiotherapy directly to the tumor via an endorectal applicator, sparing the adjacent normal tissues from excessive radiation exposure. HDREBT includes contact X-ray brachytherapy and high-dose-rate intracavitary brachytherapy. We introduce the latest developments in applicators and imaging techniques for HDREBT in rectal cancer and summarize the current evidence on the efficacy, safety, and feasibility of HDREBT as a neoadjuvant, definitive, or palliative treatment option for all stages of rectal cancer patients. We also discuss the potential advantages and challenges of HDREBT in achieving organ preservation and improving the quality of life of rectal cancer patients. HDREBT has shown promising results in achieving high complete response rates, enabling nonoperative management, improving organ preservation rates, and providing effective palliation in rectal cancer patients. More studies are needed to optimize its dose and fractionation schemes in different clinical scenarios.
直肠癌是一种常见的恶性肿瘤，需要多学科治疗。通过利用直肠癌放疗中的剂量反应关系，增加放疗剂量可以提高临床完全缓解率。高剂量率腔内近距离放疗（HDREBT）是一种通过直肠内施源器将高剂量放疗直接输送到肿瘤的新技术，使相邻的正常组织免受过度辐射。HDREBT 包括接触 X 射线近距离放疗和高剂量率腔内近距离放疗。我们介绍了直肠癌中 HDREBT 的最新施源器和成像技术的发展，并总结了 HDREBT 在直肠癌各期患者作为新辅助、根治或姑息治疗选择的疗效、安全性和可行性的现有证据。我们还讨论了 HDREBT 在实现器官保留和提高直肠癌患者生活质量方面的潜在优势和挑战。HDREBT 在实现高完全缓解率、能够进行非手术治疗、提高器官保留率以及为直肠癌患者提供有效姑息治疗方面显示出了有前途的结果。需要更多的研究来优化其在不同临床情况下的剂量和分割方案。
