Comparison of Acute Toxicity with Three-dimensional vs. Intensity Modulated Radiotherapy in Patients Treated Preoperatively for Rectal Cancer

Parekh, Arti; Truong, My; Mustafa-Quresh, M.; Orlina, T.; Hartshorn, Kevan L.; Kachnic, L.

doi:10.1016/j.ijrobp.2010.07.754

Cited by 4 publications

(5 citation statements)

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“…Our findings of acute grade 2 GI toxicity of long-course radiotherapy, which were documented in 77% of patients treated with 3D-CRT and in 64% of patients treated with IMRT radiotherapy (p=0.042), are in line with Parekh et al who also found significantly higher toxicity in grade 2 bowel symptoms with 3D-CRT (61% 3D-CRT vs 30% IMRT; p=0.036) [13]. Data from our retrospective analysis are also in agreement with Samuelian et al showing no significant difference between all other acute or chronic toxicities besides grade 2 acute GI toxicity [67% of 3D-CRT patients experienced grade 2 or above GI toxicity vs 33% of IMRT patients (p = 0.004)] [14].…”

Section: Discussionsupporting

confidence: 90%

A Retrospective Comparison of Toxicity, Response and Survival of Intensity-Modulated Radiotherapy Versus Three-Dimensional Conformal Radiation Therapy in the Treatment of Rectal Carcinoma

Kouklidis,

Nikolopoulos,

Ahmed

et al. 2023

Cureus

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Introduction:The main target of neoadjuvant treatment in rectal cancer is to downstage and downsize large tumours to increase the chance of complete surgical resection, and therefore decrease the chances of local recurrence. With or without the addition of chemotherapy, until recently, three-dimensional conformal radiotherapy (3D-CRT) used to be the radiotherapy treatment modality of choice. However, intensitymodulated radiotherapy (IMRT) is being increasingly adopted by many radiotherapy centres as a more modern, conformal technique due to its ability to minimize radiation dose to nearby organs. The aim of our analysis was to assess the difference in toxicity, response to treatment, and survival between the patients treated with these two different treatment modalities in our institution.Methods: We performed a retrospective analysis of data and compared two groups of patients with locally advanced rectal cancer who were treated with either 3D-CRT or IMRT. The main outcomes were radiation toxicity and response to treatment. Overall survival was a secondary outcome.Results: One hundred and thirty-six patients were included in the study: 71 patients treated with 3D-CRT and 65 patients treated with IMRT. With regard to toxicity, there was no significant difference between the groups for bladder and skin toxicity, but there was a significant reduction in acute grade 2 bowel toxicity in patients treated with a long course of IMRT [3D-CRT 77% (48/62) vs IMRT 64% (30/47) p=0.042]. There was no statistically significant difference in the treatment response rates of these two radiotherapy treatment modalities, as well as in overall survival between the groups (p=0.604). Conclusion:Our study showed that IMRT can significantly reduce acute bowel side effects for patients undergoing neoadjuvant radiotherapy for locally advanced rectal cancers. Further studies are needed to confirm the clinical advantage of IMRT in rectal carcinoma.

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Section: Discussionsupporting

confidence: 90%

A Retrospective Comparison of Toxicity, Response and Survival of Intensity-Modulated Radiotherapy Versus Three-Dimensional Conformal Radiation Therapy in the Treatment of Rectal Carcinoma

Kouklidis,

Nikolopoulos,

Ahmed

et al. 2023

Cureus

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“…Figure 1(a, b) shows the most commonly used regimens. 24–52 Here, a biologically effective dose (BED) was calculated according to a linear–quadratic (LQ) model of radiation effect. BED was evaluated at the isocenter.…”

Section: The Era Of 3d-crtmentioning

confidence: 99%

“…Given the different combination schemes of dose fractionation and time to surgery, a goal interval of 6–8 weeks is the most commonly used value in clinical trials [Figure 2(a)]. 5,15,17,18,21,24,27,28,31,32,34–36,38–42,44,46–48,50,52,55–94 Moreover, because of factors such as acute radiation reaction, there are some discrepancies between the goal intervals and true intervals. 95 Despite limited samples, a linear correlation can be observed between them in Figure 2(b).…”

Section: The Era Of 3d-crtmentioning

confidence: 99%

Dose–time fractionation schedules of preoperative radiotherapy and timing to surgery for rectal cancer

et al. 2020

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Chemoradiotherapy (CRT) is extensively used prior to surgery for rectal cancer to provide significantly better local control, but the radiotherapy (RT), as the other component of CRT, has been subject to less interest than the drug component in recent years. With considerable developments in RT, the use of advanced techniques, such as intensity-modulated radiotherapy (IMRT) in rectal cancer, is garnering more attention nowadays. The radiation dose can be better conformed to the target volumes with possibilities for synchronous integrated boost without increased complications in normal tissue. Hopefully, both local recurrence and toxicities can be further reduced. Although those seem to be of interest, many issues remain unresolved. There is no international consensus regarding the radiation schedule for preoperative RT for rectal cancer. Moreover, an enormous disparity exists regarding the RT delivery. With the advent of IMRT, variations will likely increase. Moreover, time to surgery is also quite variable, as it depends upon the indication for RT/CRT in the clinical practices. In this review, we discuss the options and problems related to both the dose–time fractionation schedule and time to surgery; furthermore, it addresses the research questions that need answering in the future.

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“…Newer techniques like IMRT or RA can reduce the frequency of these acute toxicities, such as gastrointestinal toxicity than conventional treatments. 2,[10][11][12] RA has the added benefit of faster treatment with lesser intrafraction error probability. Recently, the concept of BMS RT used in gynecological cancers resulted in reduction of acute HT.…”

Section: Discussionmentioning

confidence: 99%

“…1 Intensity-modulated radiotherapy (IMRT) has shown to reduce acute bowel toxicity, treatment breaks and hospitalisations. 2,3 The destruction of radiosensitive marrow cells by pelvic radiation causes acute myelosuppression. Studies on pelvic malignancies including rectal cancer concluded that radiation dose to pelvic bone marrow is a predictor of haematological toxicity (HT).…”

Section: Introductionmentioning

confidence: 99%

Bone marrow sparing RapidArc treatment in locally advanced rectal cancer – can it reduce haematological toxicity?

et al. 2023

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Context: Haematological toxicities are seen in rectal cancer patients receiving concurrent chemoradiotherapy (CRT) with capecitabine. Aims: To compare dose volume histogram (DVH) parameters and acute haematological toxicities using RapidArc with or without bone marrow constraints for rectal cancer patients receiving pelvic chemoradiation as part of curative treatment. Setting and designs: This is a prospective randomised controlled study including patients with rectal cancer initiated on chemoradiation. Patients were stratified into two arms, bone marrow sparing (BMS) arm and non-bone marrow sparing arm (NBMS). Materials and methods: DVH parameters and weekly toxicity data were collected. Grade 2 or more anaemia, leucopenia, neutropenia, or thrombocytopenia, any blood transfusions, colony-stimulating factor injection, platelet transfusions were considered as an event in acute haematological toxicity (HT). Statistical analysis: Independent t-test was used to compare quantitative parameters, and Mann–Whitney U-test was used for ordinal parameters between groups. Results: A total of 43 patients were enrolled. Bone marrow constraints were achieved without compromising the target coverage. There was a significant reduction in the bone marrow dose with BMS technique (p < 0·05). A 16·7% reduction in the HT (33·3% versus 50%) and a 21·9% reduction in the grade 2 or more anaemia (19% versus 40·9%) were noted in the BMS arm when compared to NBMS arm, though not statistically significant. However, in the preoperative setting, a significant reduction in grade 2/more anaemia (7·1% versus 41·1%, p = 0·035) was noticed in the BMS arm. Conclusions: Pelvic BMS radiotherapy may benefit patients receiving chemoradiation for locally advanced carcinoma rectum as part of curative treatment.

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Comparison of Acute Toxicity with Three-dimensional vs. Intensity Modulated Radiotherapy in Patients Treated Preoperatively for Rectal Cancer

Cited by 4 publications

References 0 publications

A Retrospective Comparison of Toxicity, Response and Survival of Intensity-Modulated Radiotherapy Versus Three-Dimensional Conformal Radiation Therapy in the Treatment of Rectal Carcinoma

A Retrospective Comparison of Toxicity, Response and Survival of Intensity-Modulated Radiotherapy Versus Three-Dimensional Conformal Radiation Therapy in the Treatment of Rectal Carcinoma

Dose–time fractionation schedules of preoperative radiotherapy and timing to surgery for rectal cancer

Bone marrow sparing RapidArc treatment in locally advanced rectal cancer – can it reduce haematological toxicity?

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