Neoadjuvant chemoradiotherapy delivered with helical tomotherapy under daily image guidance for rectal cancer patients: efficacy and safety in a large, multi-institutional series

Abstract

Purpose Helical tomotherapy (HT) has been recently introduced in the neoadjuvant treatment of locally advanced rectal cancer. Aim of this study is to report the toxicity and local control rates of a large series of locally advanced rectal cancer patients treated with neoadjuvant chemotherapy and HT under daily image guidance followed by surgery. Methods Data from 117 locally advanced rectal cancer patients treated at two Swiss Radiotherapy departments were collected and analyzed. Radiotherapy consisted of 45 Gy (1.8 Gy/fraction, 5 fractions/week delivered in 5 weeks) to the regional pelvic lymph nodes. Seventy patients also received a simultaneous integrated boost (SIB) up to 50 Gy to the tumor and involved nodes (2 Gy/fraction, 5 fractions/week delivered in 5 weeks). Chemotherapy consisted of capecitabine 825 mg/m 2 , twice daily, during the irradiation days. After a median interval of 59 days [95% confidence interval (CI) 53–65 days), all patients underwent surgery. Results Median follow-up was 45 months (range 4–90 months). The overall rate of acute grade 2–4 toxicity was 18.8% ( n = 22). Four patients (3.4%) presented a grade 3 dermatitis ( n = 1) or diarrhea ( n = 3), and 1 (0.8%) demonstrated grade 4 rectal toxicity. No patients presented with grade ≥ 3 hematologic toxicity. Six patients (5.1%) had late grade 3 gastrointestinal toxicity. The 4-year local control rate was 88.4% (95% CI 87.5–88.5%). Conclusions Neoadjuvant chemoradiotherapy delivered with HT under daily image guidance is well tolerated and shows a high 4-year local control rates.

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

“…155 Point: IMRT improves clinical endpoints Multiple retrospective studies have shown that preoperative IMRT or volumetric-modulated arc therapy (VMAT, arc-based IMRT) is associated with a clinically significant reduction in GI or genitourinary (GU) toxicity, with or without improvement in LC compared with 3D-CRT. 106,107,[170][171][172] Furthermore, these modalities can potentially prevent delays in time to surgery and reduce hospitalizations, emergency department visits, and treatment breaks. 173 However, no significant differences were noted in tumor responses, DFS and OS.…”

Avaliação dos tratamentos quimioterápicos utilizados na terapia de câncer colorretal: Uma revisão narrativa

“…Os pesquisadores mostraram que a quimiradioterapia administrada com a TH sob orientação diária da imagem é segura, com baixas taxas de toxicidade aguda e tardia. Foi proposto que técnicas altamente conformes, sob orientação diária da imagem, possam ser o padrão de tratamento no tratamento neoadjuvante de pacientes com câncer retal localmente avançado (De Bari et al, 2019). Os trabalhos apresentados por de Yang et al, (2019), Yu et al, (2018) e Araujo-Mino et al, (2018) avaliaram a utilização da quimioterapia e radioterapia em relação a segurança e eficácia, além da toxicidade.…”

Long‐term adverse effects and healthcare burden of rectal cancer radiotherapy: systematic review and meta‐analysis

“…The number of patients in the cohort was not reported at 5 years and only 11 remained at 10 years, therefore the 2 year time-point was used. Two studies reported no GU complications (117 and 69 patients respectively 36,37 ) so contributed no information to the meta-analysis.…”