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GEC-ESTRO Gastro-Intestinal

The rectal and anal GEC ESTRO sub group was initially set up to promote brachytherapy in rectal and anal cancer. In 2018 our group was extended to include the whole of the GI tract as there is a need to promote brachytherapy in other GI sites such as; oesophagus, liver and biliary tract.

1.            To stimulate interest in GI brachytherapy.

2.            To establish the role of brachytherapy in GI sites

3.            To facilitate research including multicentre Phase 2 and 3 clinical trials.

4.            To encourage education in GI brachytherapy.

5.            To promote outcome collection and publication.

1. There is an annual Papillon training course at Clatterbridge every October to train clinicians interested in using contact X-ray brachytherapy (using the Papillon technique) for rectal cancer. Those interested in attending please contact Prof Sun Myint/ Clatterbridge Cancer Centre, UK.

2. The Royal College of Radiologists, UK runs a regular brachytherapy course which includes GI brachytherapy.

1. The International Contact Radiotherapy network (ICONE) representing the rectal brachytherapy interests of the GI GEC group hold an annual scientific meeting on Saturday morning during the annual ESTRO meeting.

2. GI GEC working group meetings are held before the annual GEC ESTRO workshops.

1. CONTEM 1- This is a prospective cohort evaluating the role of post-operative CXB in pT1 cN0cM0 following local surgical excision for early rectal cancer cT1 (<2cm) in patients not suitable for surgery or in patients refusing surgery.

2. CONTEM 2 and 3  These two cohorts evaluate the role of CXB boost in more advanced cT2 cN0 tumours (>2cm) in either surgically fit patients refusing surgery (CONTEM 2) or older patients who are not suitable for surgery (CONTEM 3). These will evaluate the role CXB (Papillon) for residual disease following external beam chemo-radiotherapy (EBCRT) or external beam radiotherapy (EBRT).  Residual tumour <2cm can be offered TEMS after EBCRT and CXB.

3. OPERA (clinical trials.gov NCT02505750) – This is an ongoing phase 3 multi-centred European randomised trial set up to evaluate the role of CXB boost following EBCRT. The randomisation is between EBRT boost and CXB boost following EBCRT for cT2cT3a /cN0 cN1 <5cm. The end point is organ preservation at 3 years. The trial started in June 2015 and closed to recruitment in June 2020.

4. CITRuS This is a 3 part study examining PROMS in patients undergoing surgery or radiotherapy for the radical treatment of rectal cancer. CITRuS1 will examine the feasibility and acceptability of an online PROMS platform. CITRuS2 will identify symptoms and symptom clusters which may benefit from intervention and examine the electronic delivery of interventions. CITRuS3 will be a randomised study examining the delivery of interventions compared to online PROMS only.

An international database for early rectal cancer treated by CXB was set up in Guildford and NICE (National Institute for Health and Care Excellence) guidance recommends its use for patients with early rectal cancer treated with CXB in the UK. There is also the capability to enter data for more advanced rectal cancers treated by CXB or HDR brachytherapy and also for surgical patients for comparison. Please visit www.colorectaldatabase.com to sign up for use.

If you are interested in any of our activities and would like to join the group please contact:
Dr Alex Stewart, St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford, UK
Alexandra.stewart@nhs.net

We are particularly keen to grow the input for GI brachytherapy for disease sites other than rectum so please step forwards and get involved.

Chair: Alex Stewart, Guildford, UK

Amandeep Dhadda, Hull, UK

Ane Appelt, Leeds, UK

Arthur Sun Myint, Liverpool, UK

Desmond O'Farrell, Boston, USA

Efstratios Karagiannis, Cyprus

Evert Van Limbergen, Maastricht , NL

Frank Verhaegen, Maastricht , NL

Jean Pierre Gerard , Nice, FR

Jérôme Durand Labrunie, Villejuif, FR

Krzysztof Bujko, Warsaw, PL

Maaike Berbee, Maastricht , NL

Maria Antonietta Gambacorta, Rome, IT

Phillip Devlin, Boston, USA

Raj Sripadam, Clatterbridge, UK

Reena Engineer, Bombay, IN

Te Vuong, Montréal, CA

Véronique Vendrely , Bordeaux, FR

Stewart AJ, Van Limbergen EJ, Gerard J-P, Appelt AL, Verhaegen F, Berbee M, Vuong T, Brooker C, Rockall T, Sun Myint A. GEC ESTRO ACROP consensus recommendations for contact brachytherapy for rectal cancer. 2021 Dec 11; ctRO 33; 15-22

MJD Dunstan, TA Rockall, K Potter, AJ Stewart. Radiological and clinical findings following rectal contact X-ray brachytherapy (Papillon technique)-how to assess response. J Contemp Brachytherapy. 2018. 10(2): 179-189.

Sun Myint A, and J.P Gerard. Role of radiotherapy in the treatment of rectal cancer in older patients. European Journal of Surgical Oncology 2020; (46): 349-357.

Sun Myint A, Stewart A, Mills J et al. Treatment: the role of contact X-ray brachytherapy (Papillon) in the management of early rectal cancer. Colorectal Disease 2019; 21 (Suppl. 1): 45–52

Crane S A M, Sun Myint A, Moran B. Colorectal Disease 2019; 21 (Suppl. 1): 4–5

Smith F, Pritchard DM, Sun Myint A et al. A cohort study of local excision followed by adjuvant therapy incorporating a contact X-ray brachytherapy boost instead of radical resection in 180 patients with rectal cancer. Colorectal Disease 2019; Colorectal Dis. 2019; 21(6):663-670.                 doi: 10.1111/codi.14584.

Sun Myint A, Smith FM, Gollins S et al. Dose Escalation Using Contact X-ray Brachytherapy After External Beam Radiotherapy as Nonsurgical Treatment Option for Rectal Cancer: outcomes From a Single-Center Experience. Int J Radiat Oncol Biol Phys 2018; 100: 565–73.                                            doi: 10.1016/j.ijrobp.2017.10.022.

If you are interested in any of our activities and would like to join the group please contact: Alex Stewart