Complete pathological responses in locally advanced rectal cancer after preoperative IMRT and integrated-boost chemoradiation

Hernando-Requejo, Ovidio; López, M.; Cubillo, Antonio; Rodriguez, A.; Ciérvide, R.; Valero, J.; Sánchez, E.; Garcia-Aranda, M.; Rodriguez, J Delgado; Potdevin, G.; Rubio, Carmen

doi:10.1007/s00066-014-0650-0

Cited by 52 publications

(40 citation statements)

References 30 publications

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“…To the best of our knowledge, Hernando-Requejo et al reported excellent pCR rates using the concomitant-boost IMRT dose fractionation scheme (35). Seventy-four patients were treated with concomitant-boost IMRT (57.5 Gy in 23 fractions and concurrent 825 mg/m 2 Cap bid), and the pCR and grade 3 toxicity rates were 30.6 and 17.6%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Positive outcomes due to IMRT plus Cap treatment have been observed, with pCR rates ranging from 14.1% to 30.6% in patients with grade 3 disease, who comprised 11.1% to 17.6% of the study populations (33–35), but these studies did not mention cases of PD. Lu et al (36) only reported a pCR in 20% of the cases with a 22% rate of grade 3 toxicity, and PD in 17% of the cases.…”

Section: Discussionmentioning

confidence: 99%

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Chemoradiotherapy and concurrent radiofrequency thermal therapy to treat primary rectal cancer and prediction of treatment responses

et al. 2016

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The present study aimed to evaluate a previously reported predictive formula of output-limiting symptoms induced by radiofrequency (RF) to determine the efficacy of this neoadjuvant chemoradiation (NACR) and concurrent RF thermal therapy. The present study included 81 consecutive patients with confirmed diagnoses of rectal adenocarcinoma that was localized in the mid-low rectum (up to 12 cm from the anal verge) who received NACR [intensity-modulated radiotherapy (IMRT), 50 Gy/25 fractions, capecitabine 1,700 mg/m2/day for 5 days/week)] with concurrent thermal therapy (Thermotron-RF8, once a week for 5 weeks with 50 min irradiation). Patients with progressive disease (PD) did not receive RF outputs higher than the predicted value. Some patients who were predicted to receive more output in fact received more than the predicted output. In patients who were predicted to receive moderately higher outputs, 37.5% of the patients experienced pathological complete responses, which was the highest rate, while in those who did not receive more than the predicted output, 66.7% of the patients experienced PD, which was the highest rate in the present study. We speculate that RF thermal therapy may offset the chemoradiation effects in some patients. Adding thermal therapy as a multimodality therapy to NACR potentially affects patients with lower predicted outputs and actual observed outputs slightly higher than the predictive value. Our predictive equation for initial energy output, in which output-limiting symptoms can be used to predict treatment efficacy, consequently, can be used to decide whether to continue this treatment modality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chemoradiotherapy and concurrent radiofrequency thermal therapy to treat primary rectal cancer and prediction of treatment responses

et al. 2016

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“…Most articles about IMRT were anal cancer or nonspecific locations of rectum. [10,25,26] Till now, no article demonstrates the outcomes of neoadjuvant CCRT for lower 3rd rectal cancer with conventional fraction IMRT and concurrent fluoropyrimidine CT. Five-year overall survival rate, disease-free survival rate, and local recurrence rate for lower rectal cancer patients in group II were 70%, 70%, and 3%, respectively (Figs.…”

Section: Discussionmentioning

confidence: 99%

“…Early data from retrospective series and phase II trials suggest good compliance, low rates of acute bowel toxicity, and high complete pathologic response rates after preoperative IMRT with concurrent fluoropyrimidine therapy. [10–13] However, there are no randomized trials comparing IMRT with conventional 3D-CRT, and its routine use cannot yet be recommended.…”

Section: Introductionmentioning

confidence: 99%

The outcomes of therapeutic decision in lower 3rd rectal cancer patients

Chen

Wei²,

Hsieh

et al. 2016

Medicine

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To investigate the outcomes of the selective neoadjuvant concurrent chemoradiotherapy (CCRT) in lower 3rd rectal cancer patients in different groups (with or without neoadjuvant CCRT), especially in survival rate, local recurrence rate, and sphincter preservation rate.From January 1999 to December 2012, 69 consecutive patients who had histologically proven adenocarcinoma of lower 3rd rectum, defined preoperatively as lower tumor margin within 7 cm from the anal verge as measured by rigid sigmoidoscopy, received total mesorectum excision (TME). Our inclusion criteria of neoadjuvant CCRT are lower 3rd rectal cancer, stage II/III, and large (diameter >5 cm or >1/2 of circumference). Neoadjuvant concurrent CCRT had begun to apply lower 3rd rectal cancer patients or not. The radiation techniques of neoadjuvant CCRT for lower 3rd rectal cancer patients were all conventional fraction intensity modulated radiotherapy (IMRT) and concurrent fluoropyrimidine chemotherapy.Five-year overall survival rate, disease-free survival rate, and local recurrence rate for lower 3rd rectal cancer patients in group I were 51%, 45%, and 25%, respectively. On the contrary, 5-year overall survival rate, disease-free survival rate, and local recurrence rate for lower rectal cancer patients in group II were 70%, 70%, and 3%, respectively. The 5-year sphincter sparing rate was increased from 38.2% to 100% after the beginning of neoadjuvant CCRT. Analyzing local recurrence, overall survival rate, disease-specific survival rate, and sphincter sparing rate in group II were statistically significant superior to group I.Five-year overall survival rate, disease-free survival rate, and sphincter sparing rate for lower 3rd rectal cancer patients were improved after the addition of neoadjuvant CCRT. No unacceptable toxicity was noted after conventional fraction IMRT and concurrent fluoropyrimidine chemotherapy. Our study showed neoadjuvant CCRT could be valuable for lower 3rd rectal cancer patients.

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“…anal cancer, and has previously been integrated into the neoadjuvant treatment of locally advanced rectal cancer [32][33][34]. As such, many of the technical challenges of treatment delivery are well understood, including estimation of treatment margins and use of imaging for treatment verification.…”

Section: External Beam Radiotherapymentioning

confidence: 99%

Radiation Techniques for Increasing Local Control in the Non-Surgical Management of Rectal Cancer

Appelt

Jakobsen

2015

Curr Colorectal Cancer Rep

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A fraction of patients with rectal cancer can achieve clinical complete response following longcourse chemoradiotherapy (CRT), and there is accumulating clinical evidence that these patients can be managed non-surgically with acceptable oncological outcome. Consequently, strategies for increasing the proportion of complete responders are actively being explored. Some, although limited, experience with high-dose radiotherapy indicates that there might exist a dose-response relationship for local tumour control after radiotherapy alone. Thus, tumour dose escalation could be indicated for selected patients, particularly in cases with small tumours and limited local disease. This report discusses several radiotherapy techniques for tumour boosting, focusing on technical challenges and clinical experiences with each technique. Specifically, external beam radiotherapy, brachytherapy and contact X-ray treatment for dose escalation are considered. Ultimately, no technique provides definitive advantage over others, and the choice in clinical practice will have to depend on the patient population treated as well as the technical capabilities of the treating department.

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Complete pathological responses in locally advanced rectal cancer after preoperative IMRT and integrated-boost chemoradiation

Cited by 52 publications

References 30 publications

Chemoradiotherapy and concurrent radiofrequency thermal therapy to treat primary rectal cancer and prediction of treatment responses

Chemoradiotherapy and concurrent radiofrequency thermal therapy to treat primary rectal cancer and prediction of treatment responses

The outcomes of therapeutic decision in lower 3rd rectal cancer patients

Radiation Techniques for Increasing Local Control in the Non-Surgical Management of Rectal Cancer

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