Sphincter-saving surgery for failed organ preservation after a neoadjuvant therapy and radiation boost - A surgeon’s perspective

Q: What is BoRT and why is it used in low rectal cancer treatment?

BoRT, also referred to as contact brachytherapy, is used to intensify radiotherapy with the goal of increasing organ preservation rates in low rectal cancers.

Q: How does the study compare BoRT with standard chemoradiotherapy?

A retrospective analysis of 145 patients is performed, with propensity score matching based on age, sex, BMI, and tumor distance from the anal verge to compare BoRT-treated patients with non-BoRT controls.

Q: What functional outcomes differ after stoma reversal between the groups?

Patients in the BoRT group show significantly worse functional outcomes, including higher (worse) LARS scores and higher Wexner scores six months after stoma reversal, while Kirwan grade is consistent between groups.

Sep 23, 2026

Uploaded by Kyle

Functional outcomes for low rectal cancer patients undergoing inter-sphincteric resection (ISR) after brachytherapy boost radiotherapy (BoRT) are assessed against outcomes after standard chemoradiotherapy. The retrospective single-institution study includes 145 patients treated from 2013 to 2021, with propensity score matching comparing 18 BoRT patients to 127 controls. Six months after stoma reversal, LARS, Wexner, and Kirwan measures evaluate sphincter function. Results show markedly worse LARS and higher Wexner scores after BoRT, while Kirwan grade remains similar.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Abstract

Purpose

Method

Results

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Introduction

Materials and methods

Singh et al. BMCGastroenterology (2025) 25:384 [https://doi.org/10.1186/s12876-025-03908-w](https://doi.org/10.1186/s12876-025-03908-w) BMC Gastroenterology RESEARCH Open Access Sphincter-saving surgery for failed organ preservation after a neoadjuvant therapy and radiation boost: A surgeon’s perspective Sanjay Singh1† , Abdeali Saif Arif Kaderi1† , Mufaddal Kazi 1 , Ashwin Desouza 1 , Ankit Sharma1 , Suman Kumar Ankathi2 and Avanish Saklani1* Abstract Purpose This study investigates the functional outcomes of patients with low rectal cancer undergoing inter-sphincteric resection (ISR) following brachytherapy boost radiotherapy (BoRT), compared to those who underwent ISRafter standard chemoradiotherapy. BoRT is an alternative to total neoadjuvant therapy for increasing organ preservation rates in low rectal cancers. However, its impact on sphincter function following stoma reversal remains unclear. Method The study involved a retrospective analysis of 145 patients treated at a single institution between 2013 and 2021. Eighteen patients received pre-operative BoRT and were compared with 127 patients who did not, using propensity score matching based on age, sex, body mass index, and tumor distance from the anal verge with match ratio 1:4 . Functional outcomes were assessed six months post-stoma reversal using the Low Anterior Resection Syndrome (LARS) Score, Wexner Score, and Kirwan Grade. Results The results revealed that patients in the boost RT group had significantly worse functional out comes, with a median LARS score of 36 (very high) compared to 10 in the no boost group (p < 0. 001) . Similarly, the median Wexner score was higher in the boost RT group (17 vs. 8, p < 0. 001) . The Kirwan Grade was consistent across both groups. Conclusion This study highlights the detrimental impact of BoRT on functional status, underscoring the importance of comprehensive patient counselling before initiating BoRT in candidates eligible for sphincter preservation. If optimal outcomes are not achieved following brachytherapy boost, surgical options like ISR or APR should be thoroughly discussed with patients to ensure informed decision-making. Keywords Brachytherapy boost radiotherapy, Contact X ray brachytherapy, Intersphincteric resection, Salvage surgery, Sphincter preservation †Sanjay Singh and Abdeali Saif Arif Kaderi are co-first authors. *Correspondence: Avanish Saklani[asaklani@hotmail.com](asaklani@hotmail.com) 1 Department of Colorectal and Robotic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Dr Ernest Borges Rd, Parel, Mumbai, Maharashtra 400012, India 2 Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra 400012, India Introduction In recent years, non-surgical management of low rectal cancer has increased, thanks to concept of Total neoadjuvant therapy (TNT) [1] and intensified dose of radiotherapy [2]. This includes either induction or consolidation chemotherapy to either long course [3] or short course radiotherapy [4]. Brachytherapy Boost radiotherapy (BoRT) or contact brachytherapy (CXB) has been employed in selective centres to improve organ © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons lice

FAQs

What is BoRT and why is it used in low rectal cancer treatment?

BoRT, also referred to as contact brachytherapy, is used to intensify radiotherapy with the goal of increasing organ preservation rates in low rectal cancers.

How does the study compare BoRT with standard chemoradiotherapy?

A retrospective analysis of 145 patients is performed, with propensity score matching based on age, sex, BMI, and tumor distance from the anal verge to compare BoRT-treated patients with non-BoRT controls.

What functional outcomes differ after stoma reversal between the groups?

Patients in the BoRT group show significantly worse functional outcomes, including higher (worse) LARS scores and higher Wexner scores six months after stoma reversal, while Kirwan grade is consistent between groups.

Sep 23, 2026

Uploaded by Kyle