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High\u2010dose rate endorectal brachytherapy (HDREBT) is a novel technique that delivers high doses of radiotherapy directly to the tumor via an endorectal applicator, sparing the adjacent normal tissues from excessive radiation exposure. HDREBT includes contact X\u2010ray brachytherapy and high\u2010dose\u2010rate intracavitary brachytherapy. We introduce the latest developments in applicators and imaging techniques for HDREBT in rectal cancer and summarize the current evidence on the efficacy, safety, and feasibility of HDREBT as a neoadjuvant, definitive, or palliative treatment option for all stages of rectal cancer patients. We also discuss the potential advantages and challenges of HDREBT in achieving organ preservation and improving the quality of life of rectal cancer patients. HDREBT has shown promising results in achieving high complete response rates, enabling nonoperative management, improving organ preservation rates, and providing effective palliation in rectal cancer patients. More studies are needed to optimize its dose and fractionation schemes in different clinical scenarios.<\/jats:p>","DOI":"10.1111\/cas.15959","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T09:42:37Z","timestamp":1694598157000},"page":"4145-4156","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["High\u2010dose rate endorectal brachytherapy for rectal cancer: A state\u2010of\u2010the\u2010art review"],"prefix":"10.1111","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4288-7354","authenticated-orcid":false,"given":"Tian","family":"Cheng","sequence":"first","affiliation":[{"name":"Cancer Center Peking University 3rd Hospital  Beijing China"},{"name":"Peking University Health Science Center Peking University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Peking University 3rd Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ang","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Peking University 3rd Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wang","sequence":"additional","affiliation":[{"name":"Cancer Center Peking University 3rd Hospital  Beijing China"},{"name":"Department of Radiation Oncology Peking University 3rd Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13092025"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000141194.27992.32"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.05.017"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000257358.56863.ce"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2017.72607"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2019.00208"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(89)90121-1"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2015.51402"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2007.07.018"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2023.127051"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14153665"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.02.006"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.05.023"},{"key":"e_1_2_10_15_1","article-title":"Clinicopathologic comparison of high\u2010dose\u2010rate endorectal brachytherapy versus conventional chemoradiotherapy in the neoadjuvant setting for resectable stages II and III low rectal cancer","volume":"2012","author":"Smith JA","year":"2012","journal-title":"Int J Surg Oncol"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2005.07.969"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-6455-y"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9098(199706)65:2<76::AID-JSO2>3.0.CO;2-K"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2022.02.022"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2020.03.009"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2364054"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2019.02.001"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/s22041328"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2021.03.011"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/41321492"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/60198873"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2015.51290"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2020.06.010"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4915920"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040694"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gassur.2006.09.005"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181dae4ed"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000281"},{"key":"e_1_2_10_34_1","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/978-3-319-44827-5_11","volume-title":"Gastrointestinal Brachytherapy: Anal and Rectal Cancer. 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