Intensity-Modulated Radiation Therapy for Rectal Carcinoma Can Reduce Treatment Breaks and Emergency Department Visits

Abstract

Purpose. To compare the acute toxicities of IMRT to 3D-conformal radiation therapy (3DCRT) in the treatment of rectal cancer. Methods and Materials. Eighty-six patients with rectal cancer preoperatively treated with IMRT (n = 30) and 3DCRT (n = 56) were retrospectively reviewed. Rates of acute toxicity between IMRT and 3DCRT were compared for anorexia, dehydration, diarrhea, nausea, vomiting, weight loss, radiation dermatitis, fatigue, pain, urinary frequency, and blood counts. Fisher's exact test and chi-square analysis were applied to detect statistical differences in incidences of toxicity between these two groups of patients. Results. There were fewer hospitalizations and emergency department visits in the group treated with IMRT compared with 3DCRT (P = 0.005) and no treatment breaks with IMRT compared to 20% with 3DCRT (P = 0.0002). Patients treated with IMRT had a significant reduction in grade ≥3 toxicities versus grade ≤2 toxicities (P = 0.016) when compared to 3DCRT. The incidence of grade ≥3 diarrhea was 9% among 3DCRT patients compared to 3% among IMRT patients (P = 0.31). Conclusions. IMRT for rectal cancer can reduce treatment breaks, emergency department visits, hospitalizations, and all grade ≥3 toxicities compared to 3DCRT. Further evaluation and followup is warranted to determine late toxicities and long-term results of IMRT.

The Impact of Novel Radiation Treatment Techniques on Toxicity and Clinical Outcomes in Rectal Cancer

“…2). When compared to 3DCRT, IMRT did not result in improved pCR (26-28) or tumor downstaging rates (15, 28). The improvement of the sphincter-preservation rate with IMRT is controversial.…”

“…Although IMRT significantly reduced all grade ≥ 3 toxicities, the rate of grade ≥ 3 GI toxicity was similar between the IMRT and 3DCRT groups. Multi-agent chemotherapy was associated with increased toxicity compared to single agent chemotherapy (28). …”

“…Three retrospective studies have evaluated the rates of HT among patients treated with IMRT compared to those treated with 3DCRT. Jabbour et al reported a significantly reduced rate of grade ≥ 3 HT versus grade ≤ 2 HT with IMRT in patients treated with preoperative chemoradiotherapy (28). Newman et al quantified bone marrow suppression during postoperative chemotherapy in patients previously treated with preoperative chemoradiotherapy (with 5-FU or capecitabine) (43).…”

Bone marrow tolerance during postoperative chemotherapy in colorectal carcinomas

“…Rectal cancer patients underwent radiation treatment consistent with Radiation Therapy Oncology Group treatment guidelines for rectal cancers (12,15,16). Patients were treated with either intensity-modulated radiation therapy (IMRT) (n=20, 57.1%) or 3D-conformal radiation therapy (3D-CRT) (n=15, 42.8%) to a median dose of 50.4 Gy (range: 48.6-54 Gy) in 1.8 Gy/day fractions.…”

Rectal cancer

“…Radiation toxicity has been substantially reduced since data of large studies analyzing the pattern of local failure permitted a reduction of field size [26]. Innovative techniques such as intensity-modulated (IMRT; [20]) and image-guided (IGRT; [13]) radiotherapy will further permit adverse effects to be minimized. Individual response and toxicity scores [47] may be another promising tool and new concepts for systemic treatment are warranted for patients at risk of distant metastases [6,33,34,46].…”