Yusuf KAVUZLU, Dilek NURLU, Doğan ALBAYRAK, Şule PARLAR, Gökay YILDIZ, Seda DEMİR, Bülent ERDOĞAN, Zafer KOÇAK, Mert SAYNAK
Turkish Journal of Oncology - 2026;41(2):146-159
The management of locally advanced rectal cancer has progressively evolved from a surgery-oriented model toward response-adapted strategies that prioritize organ preservation, functional outcomes, and quality of life. Within this framework, radiotherapy-based dose escalation has gained increasing interest as a means of enhancing tumor regression beyond that achieved with standard chemoradiotherapy alone. Contact X-ray brachytherapy (CXB) and endoluminal high-dose-rate (HDR) brachytherapy represent two localized radiation techniques with distinct physical and dosimetric characteristics. CXB delivers extremely high surface doses with limited tissue penetration, whereas HDR endorectal brachytherapy provides greater depth-dose distribution and the potential to deliver dose not only to the mucosal tumor surface but also to tissues adjacent to the rectal wall, including limited intramesorectal extensions. Contemporary ASTRO and ESMO guidelines support multidisciplinary, MRI-based, risk-adapted treatment selection and recognize the importance of sequencing within total neoadjuvant treatment (TNT), particularly when organ preservation or non-operative management is a therapeutic goal. Evidence from recent trials suggests that localized dose escalation may improve complete response and organ preservation.
