Escalated radiation dose alone vs. concurrent chemoradiation for locally advanced and unresectable rectal cancers: results from phase II randomized study

Mohandas, K. M.; Shukla, Pragya; Shrikhande, Shailesh V.; Mahantshetty, Umesh; Chopra, Supriya; Goel, Mahesh; Mehta, Shaesta; Patil, Prachi; Ramadwar, Mukta; Deodhar, Kedar; Arya, Supreeta; Shrivastava, Shyam Kishore

doi:10.1007/s00384-012-1630-4

Cited by 17 publications

(18 citation statements)

References 10 publications

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“…The percentage of pCR can be increased by giving an additional boost dose to the gross tumor volume (GTV) [4]. This is currently being investigated in a large number of clinical trials [5][6][7][8][9][10][11][12]. For the studies where the boost is delivered using external beam radiotherapy (RT), the boost dose is either delivered over a period of weeks; in a simultaneous-integrated boost (SIB) during five weeks of standard CRT.…”

Section: Introductionmentioning

confidence: 99%

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MRI-based tumor inter-fraction motion statistics for rectal cancer boost radiotherapy

et al. 2018

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Background: In patients diagnosed with rectal cancer, dose escalation is currently being investigated in a large number of studies. Since there is little known on gross tumor volume (GTV) inter-fraction motion for rectal cancer, a wide variety in margins is used. Purpose of this study is to quantify GTV inter-fraction motion statistics on different timescales and to give estimates of planning target volume (PTV) margins. Material and methods: Thirty-two patients, diagnosed with rectal cancer, were included. To investigate motion from week-to-week, 16 patients underwent a pretreatment and five weekly MRIs, prior to a radiotherapy (RT) fraction of the chemoradiotherapy treatment. To investigate motion from day-to-day, the remaining 16 patients underwent five daily MRIs before each fraction in one week of RT. GTV was delineated on all scans according to guidelines. Scans were aligned on bony anatomy with the first MRI. For both datasets separately, GTV inter-fraction motion was determined based on center-of-gravity displacement. Therefrom, systematic and random errors were determined in left/right (LR), anterior/posterior and cranial/caudal (CC) direction. PTV margin estimates were calculated and evaluated on GTV coverage. Results: Systematic and random errors were found in the range of 2.3-4.8 mm and 1.5-3.3 mm from week-to-week, and 1.8-4.5 mm and 1.8-4.0 mm from day-to-day, respectively. On both timescales, similar motion patterns were found; the most motion was observed in CC whilst the least motion was observed in LR. On the week-to-week data more systematic and less random motion was observed compared to the day-to-day data. Overall, only slight differences in margin estimates were found. Derived PTV margin estimates were found to give adequate GTV coverage.

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Section: Introductionmentioning

confidence: 99%

“…In absence of GTV motion statistics a wide range of GTV margins are being used in ongoing boost trails, between 7 and 30 mm [6][7][8][9][10][11][12]. Substantiated GTV margins could improve these boost treatments by ensuring coverage of the GTV by the boost dose at minimal toxicity.…”

Section: Introductionmentioning

confidence: 99%

MRI-based tumor inter-fraction motion statistics for rectal cancer boost radiotherapy

et al. 2018

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“…In a unique study by Engineer et al, patients with clinically unresectable rectal cancer received 45 Gy of EBRT with concurrent oral capecitabine or EBRT alone boosted to 60 Gy. Patients experienced a pCR rate of 7% and 11% for radiation alone vs. radiation + chemo (44). The lower pCR rate in this study is perhaps not unexpected, as the dose escalated treatment arm did not include concurrent chemotherapy.…”

Section: -Dimentional Conformal Radiation Therapy (3d-crt)mentioning

confidence: 71%

“…This group of studies also emphasizes the importance of optimizing chemotherapy regimens in concert with radiotherapy. This paradigm was also supported by the result of Engineer's study, in which chemoradiation outperformed radiation alone (44). However, 3D-CRT strategies carry limitations in their ability to conformally address a circumferential target.…”

Section: -Dimentional Conformal Radiation Therapy (3d-crt)mentioning

confidence: 87%

Adaptive radiation dose escalation in rectal adenocarcinoma: a review

Wickle¹,

Paulson²,

Landry³

et al. 2017

J. Gastrointest. Oncol.

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Total mesorectal excision (TME) after neoadjuvant chemoradiotherapy (CRT) has offered superior control for patients with locally advanced rectal cancer, but can carry a quality of life cost. Fortunately, some patients achieve a complete response after CRT alone without the added morbidity caused by surgery. Efforts to increase fidelity of radiation treatment planning and delivery may allow for escalated doses of radiotherapy (RT) with limited off-target toxicity and elicit more pathological complete responses (pCR) to CRT thereby sparing more rectal cancer patients from surgery. In this review, methods of delivering escalated RT boost above 45-50.4 Gy are discussed including: 3D conformal, intensity-modulated radiotherapy (IMRT), and brachytherapy. Newly developed adaptive boost strategies and imaging modalities used in RT planning and response evaluation such as magnetic resonance imaging (MRI) and positron emission tomography (PET) are also discussed.

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“…Investigators concluded that escalated radiation dose without chemotherapy did not achieve higher complete (R0) tumor resectability in locally advanced inoperable rectal cancers, compared to concurrent chemoradiation. [25] Another prospective, double-blind, noncrossover, randomized study investigated the intensification of neoadjuvant chemotherapy (NACT) as an effective downstaging strategy. The study was designed to evaluate whether the capecitabine-oxaliplatin (Cape-Ox) combination was superior to 5-fluorouracil (5-FU)-leucovorin as radio sensitizer for neoadjuvant chemoradiation in downstaging locally advanced rectal adenocarcinoma and to compare the toxicities between the two arms.…”

Section: Radiation With or Without Chemotherapy In Rectal Cancer Audimentioning

confidence: 99%

Gastrointestinal cancers in India: Treatment perspective

Ghadyalpatil

Chopra

Patil

et al. 2016

South Asian J Cancer

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GI cancer is not one cancer but is a term for the group of cancers that affect the digestive system including gastric cancer (GC), colorectal cancer (CRC), hepatocellular carcinoma (HCC), esophageal cancer (EC), and pancreatic cancer (PC). Overall, the GI cancers are responsible for more cancers and more deaths from cancer than any other organ. 5 year survival of these cancers remains low compared to western world. Unlike the rest of the world where organ based specialities hepatobiliary, pancreatic, colorectal and esophagogastric exist, these cancers are managed in India by either a gastrointestinal surgeons, surgical oncologist, or a general surgeon with varying outcomes. The aim of this review was to collate data on GI cancers in indian continent. In colorectal cancers, data from tertiary care centres identifies the unique problem of mucinous and signet colorectal cancer. Results of rectal cancer resection in terms of technique (intersphincteric resection, extralevator aper, minimal invasive approach) to be comparable with world literature. However long term outcome and data regarding colon cancers and nationally is needed. Gastric cancer at presentation are advanced and in surgically resected patients, there is need for a trial to compare chemoradiation vs chemotherapy alone to prevent loco regional recurrence. Data on minimal invasive gastric cancer surgery may be sparse for the same reason. Theree is a lot of data on surgical techniques and perioperatve outcomes in pancreatic cancer. There is a high volume of locally advanced gallbladder cancers with efforts on to decide whether neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy is better for down staging. Considering GI cancers, a heterogeneous disease with site specific treatment options and variable outcomes, the overall data and outcomes are extremely variable. Young patients with pathology unique to the Indian subcontinent (for example, signet ring rectal cancer, GBCs) need focussed attention. Solution for such pathology needs to come from the Indian continent itself. Joint efforts to improve outcomes for GI cancer can be integrated under the national cancer grid program.

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Escalated radiation dose alone vs. concurrent chemoradiation for locally advanced and unresectable rectal cancers: results from phase II randomized study

Abstract: Escalated radiation dose without chemotherapy does not achieve higher complete (R0) tumor resectability in locally advanced inoperable rectal cancers, compared to concurrent chemoradiation.

Cited by 17 publications

References 10 publications

MRI-based tumor inter-fraction motion statistics for rectal cancer boost radiotherapy

MRI-based tumor inter-fraction motion statistics for rectal cancer boost radiotherapy

Adaptive radiation dose escalation in rectal adenocarcinoma: a review

Gastrointestinal cancers in India: Treatment perspective

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