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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 a bi-annual Papillon training course in Liverpool every March and 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. ESTRO runs an annual 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 during the annual ESTRO meeting.

2. GI GEC working group meetings are held before the annual GEC ESTRO workshops with online representation for those who cannot attend in person.

  1. OPERA (clinical trials.gov NCT02505750) – This phase 3 multi-centred European randomised trial published 5 year outcomes this year It evaluated the role of CXB boost following EBCRT for cT2cT3a /cN0 cN1 <5cm. The end point of organ preservation at 5 years showed 79% (CXB boost)  versus 56% (EBRT boost) with a rate of 93% organ preservation in patients with tumours <3cm. Further trials are in development to aim to increase the rates of cCR-EXPRESS and OPERA with IO. The TRESOR trial is open in France
     
  2. 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. Initial results have been published from this cohort
     
  3. 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.
     
  4. CITRuS (clinicaltrials.gov NCT04697394) This is a 3 part study examining PROMS in patients undergoing surgery or radiotherapy for the radical treatment of rectal cancer. CITRuS1 is an NIHR badged trial examining 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. CITRuS1 recruited 380 patients from 4 CXB and 22 non CXB centres and will enable comparison of PROMs in CXB patients in comparison to surgical and EBRT alone patients. The interventions for CITRuS2 are in development, aiming to open early 2026.
     
  5. Anal Cancer trial. Investigation of an HDR boost for anal cancer in development as a clinical trial in Italy.

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. Several multi-centre analyses have been published using this database; patients undergoing short course radiotherapy and CXB, patients undergoing sole treatment with CXB, patients undergoing reirradiation. Please visit www.colorectaldatabase.com.uk  to sign up for use.

Chair: Dr Alex Stewart, Oncologist

Past Chair: Dr Sun Myint, Oncologist

Secretary: Mrs Ciarna Brooker, RTT

For an up-to-date list of the GI GEC core group please contact Dr Alex Stewart

We welcome new members, please contact Alex to find out more.

  1. Liver brachytherapy. The consensus recommendations for interstitial brachytherapy are in the final stages, led by Prof Corradini with a multi-disciplinary panel
  2. HDR rectum. The consensus recommendations for endoluminal rectal HDR are in progress. This will be a 3 stage set of recommendations with stage 1 definition of targets and OAR nearly complete.
  3. CXB rectum. The 2022 guidelines will be updated with the OPERA trial outcomes and other prospective data published since the original guidance.

If you are interested in any of our activities please contact:

Dr Alex Stewart, Royal Surrey Cancer Centre, Royal Surrey Hospital, Guildford, UK

Alexandra.stewart@nhs.net

We are particularly keen to grow the input for GI brachytherapy for disease sites other than rectum.