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Acute and late toxicity of combined EBRT and HDR-BT was recorded according to CTCAE v5.0. Initial tumor response (clinical complete response, cCR, near clinical complete response, ncCR, and incomplete response, IR) and long-term disease control were assessed using clinical examination, endoscopy, and magnetic resonance imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median follow-up was 21 (range, 9\u201343) months. Six weeks after completion of EBRT\u202f+\u2009HDR-BT, cCR (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u20096) or ncCR (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u20096) was confirmed in 12\/15\u00a0patients (80%), 3\u00a0patients (20%) had IR. Local regrowth after initial (\n                      <jats:italic>n<\/jats:italic>\n                      )cCR was observed in 4\u00a0patients (33%). A\u00a0total of 4\/15\u00a0patients (27%) developed distant metastases (2 with IR, 2 with (\n                      <jats:italic>n<\/jats:italic>\n                      )cCR). Most common acute toxicities were mild\/moderate proctitis (grade\u00a01\u20132) in 67%, and mild grade\u00a02 cystitis in 27%. Three patients (20%), of whom two were receiving oral anticoagulation, experienced late grade\u00a03 rectal bleeding, requiring blood transfusion. One patient developed grade\u00a03 rectal ulcer with necrosis treated with rectal amputation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HDR-BT dose escalation after initial EBRT represents a\u00a0feasible non-operative treatment option for patients unfit for surgery with promising long-term local control. The incidence of late grade\u00a03 rectal bleeding, especially in patients receiving concomitant oral anticoagulation, requires careful patient selection, and further dose and treatment optimization (as implemented in the upcoming ACO\/ARO\/AIO-22\u00a0trial).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00066-026-02589-y","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T04:50:40Z","timestamp":1789361440000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Image-guided high-dose-rate brachytherapy after short-course external beam radiotherapy for elderly\/frail rectal cancer patients"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7304-8804","authenticated-orcid":false,"given":"Alexander","family":"Kristen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Tselis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Diefenhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armin","family":"Wiegering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Trojan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Dapper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Scherf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulla","family":"Ramm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Licher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"R\u00f6del","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil","family":"Fokas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Fleischmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"issue":"10449","key":"2589_CR1","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1016\/S0140-6736(24)00360-X","volume":"404","author":"C Eng","year":"2024","unstructured":"Eng\u00a0C, Yoshino\u00a0T, Ru\u00edz-Garc\u00eda\u00a0E et\u00a0al (2024) Colorectal cancer. 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