New Clinical Trial at MSK for Residual or Recurrent Anal Cancer

At Memorial Sloan Kettering, we are currently using HDR brachytherapy to treat selected patients with low-lying rectal cancers who have other medical comorbidities and/or have refused an APR. Additionally, since surgical resection is the salvage therapy for persistent or recurrent anal cancer after definitive chemoradiation, we offer HDR brachytherapy to patients with small, recurrent anal cancers.

New Clinical Trial

We are opening a new protocol to evaluate the dose per fraction of brachytherapy: determining the appropriate dose that can be delivered safely while minimizing side effects. This phase I dose-escalation study will evaluate the safety of endorectal brachytherapy with concurrent capecitabine or 5-FU in the management of locally recurrent/residual rectal or anal cancer in patients who have received pelvic external beam radiation with or without chemotherapy.

We will use MRI with dynamic contrast enhancement and diffusion weighted imaging series to enhance our assessment of tumor response.

The goal is to extend our use of brachytherapy to improve outcomes and individualize treatment of patients with rectal cancer. Given the morbidity of radical surgery, and its long-term impact on quality of life, selective nonoperative treatment may be an alternative in some cases. With appropriate use of endorectal brachytherapy, rectal surgery may be selectively omitted from the management of some rectal cancer patients. These include individuals for whom surgery poses a prohibitive risk, or who refuse to have an APR, or whose cancers respond dramatically to chemoradiation.

Brachytherapy also serves a palliative purpose in the management of patients with metastatic disease who may benefit from local therapy, but for whom radical resection is inappropriate. With advances in treatment options for rectal cancer and continued collaboration with our colleagues across disciplines, our ultimate goal is to tailor therapies based on patient risk factors and tumor characteristics, taking into account the impact of treatment on each patient’s quality of life.