Radiation dose intensification in pre-operative chemo-radiotherapy for locally advanced rectal cancer

Alongi, Filippo; Fersino, S.; Mazzola, Rosario; Fiorentino, Alba; Giaj-Levra, Niccolò; Ricchetti, F.; Ruggieri, R.; Paola, Gioacchino Di; Cirillo, Massimo; Gori, Stefania; Salgarello, Matteo; Zamboni, Giuseppe; Ruffo, Giacomo

doi:10.1007/s12094-016-1522-0

Cited by 31 publications

(31 citation statements)

References 33 publications

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“…magnetic resonance imaging, MRI) and even more on metabolic imaging suitable for predicting CRT response is constantly increasing [ 8 , 9 ]. In this regard, the role that [18F] -fluorodeoxyglucose positron emission tomography/computed tomography ([18F] FDG-PET/CT) has in staging and treatment planning of rectal cancer is still quite debatable [ 10 – 12 ] as well as in measuring treatment response [ 13 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

Does baseline [18F] FDG-PET/CT correlate with tumor staging, response after neoadjuvant chemoradiotherapy, and prognosis in patients with rectal cancer?

et al. 2018

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Background[18F] fluorodeoxyglucose positron emission tomography/computed tomography ([18F] FDG-PET/CT) may be used for tumor staging and prognosis in several tumors but its role in rectal cancer is still debated. The aim of the present study was to assess the correlation of baseline [18F] FDG-PET parameters with tumor staging, tumor response (tumor regression grade (TRG)), and outcome in a series of patients affected by locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (CRT).MethodsOne hundred patients treated with neoadjuvant CRT and radical surgery were enrolled in the present study. Maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) at the baseline [18F] FDG-PET were calculated. These PET parameters were correlated with tumor staging, histopathological data (TRG1 vs. TRG2–5 and TRG1–2 vs. TRG3–5), disease-free survival, and overall survival.ResultsSUVmax and SUVmean of primary tumor were statistically associated with T4-stage. SUVmax, SUVmean, and TLG did not result statistically associated with TRG (TRG1 or TRG1–2). MTV resulted statistically associated with TRG1–2 group (OR 2.9; 95% CI 1.2–7.1). Finally, no PET parameter was significantly associated with disease-free or overall survival.ConclusionOur results showed that baseline [18F] FDG-PET parameters correlated with tumor staging, and only MTV correlated with TRG 1–2. PET parameters failed to predict disease-free and overall survival after treatment completion. The results leave open to further studies the issue of identifying patients suitable for conservative approaches.

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Section: Introductionmentioning

confidence: 99%

Does baseline [18F] FDG-PET/CT correlate with tumor staging, response after neoadjuvant chemoradiotherapy, and prognosis in patients with rectal cancer?

et al. 2018

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“…Overall, 78% of patients completed the prescription dose (59.4 Gy in 33 fractions or 60 Gy in 30 fractions) of radiotherapy, the average radiation dose was 56.69 Gy, and the average BED was 67 Gy. Previous studies showed that a prescription dose of 54 Gy to 60 Gy (BED = 65 to 72 Gy) delivered to rectal tumors would achieve a significant tumor regression effect, and the percentage of patients with tumor regression grade (TRG) 1 and 2 was approximately 60 to 63.9% [26,27].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Primary Tumor Radiotherapy in Patients with Unresectable Stage IV Rectal or Rectosigmoid Cancer: A Propensity Score Matching Analysis for Survival.

Wang

Wang²,

Huang

et al. 2020

Preprint

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Background: To evaluate the impact of primary tumor radiotherapy on survival in patients with unresectable metastatic rectal or rectosigmoid cancer.Methods: From September 2008 to September 2017, 350 patients with unresectable metastatic rectal or rectosigmoid cancer were retrospectively reviewed in our center. All patients received at least 4 cycles of chemotherapy and were divided into two groups according to whether they received primary tumor radiotherapy. A total of 163 patients received primary tumor radiotherapy, and the median radiation dose was 56.69 Gy (50.4-60). Survival curves were estimated with the Kaplan–Meier method to roughly compare survival between the two groups. Subsequently, the 18-month survival rate was used as the outcome variable for this study. This study mainly evaluated the impact of primary tumor radiotherapy on the survival of these patients through a series of multivariate Cox regression analyses after propensity score matching (PSM).Results: The median follow-up time was 21 months. All 350 patients received a median of 7 cycles of chemotherapy (range 4-12), and 163 (46.67%) patients received primary tumor radiotherapy for local symptoms. The Kaplan–Meier survival curves showed that the primary tumor radiotherapy group had a significant overall survival (OS) advantage compared to the group without radiotherapy (20.07 vs 17.33 months; P=0.002). In this study, the multivariate Cox regression analysis after adjusting for covariates, multivariate Cox regression analysis after PSM, inverse probability of treatment weighting (IPTW) analysis and propensity score (PS)-adjusted model analysis consistently showed that primary tumor radiotherapy could effectively reduce the risk of death for these patients at 18 months (HR: 0.62, 95% CI 0.40-0.98; HR: 0.79, 95% CI: 0.93-1.45; HR: 0.70, 95% CI 0.55-0.99 and HR: 0.74, 95% CI: 0.59-0.94).Conclusion: Compared with patients with stage IV rectal or rectosigmoid cancer who did not receive primary tumor radiotherapy, those who received primary tumor radiotherapy had a lower risk of death. The prescription dose (59.4 Gy/33 fractions or 60 Gy/30 fractions) of radiation for primary tumors might be considered not only to relieve symptoms improve the survival of patients with inoperable metastatic rectal or rectosigmoid cancer.

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“…Here the V40 of the lumbosacral spine was associated with clinically significant grade ≥ 2 hematologic toxicity in patients receiving conventional concurrent CRT (50 à 2 Gy, IMRT, Capecitabine) (grade ≥ 2hematologic toxicity with V40 ≥ 60% vs. V40 < 60% was 38.3% vs.13%, p = 0.005). Interestingly, no case of severe acute toxicity was registered in a radiation dose intensification study in rectal cancer [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Dosimetric analysis and comparison of reduced longitudinal cranial margins of VMAT-IMRT of rectal cancer

et al. 2018

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BackgroundThe cranial border of the target volume (TV) in rectal cancer patients treated with neoadjuvant chemoradiation (nCRT) is mostly defined at the level of L5/S1. However, current studies have shown that relapse cranially of the target volume after neoadjuvant nCRT and surgery is very rare. A reduction of cranial TV margins could be reasonable to reduce toxicity to the organs at risk (OAR). In this study we compared the dose distribution to the OAR for different cranial longitudinal margins using a dose-volume histogram (DVH) analysis.MethodsTen patients with loco regional advanced rectal cancer were analysed retrospectively. All patients were planned for Volumetric Arc Therapy Radiation Therapy (VMAT). Next to the original PTV (PTV0), three new planning target volumes (PTV) were defined for each patient: The PTV0 reduced by 1 cm, 2 cm and 3 cm on cranial extension. For each PTV a treatment plan with a total dose of 50.4 Gy with daily doses of 1.8 Gy was calculated. Dose to the OAR were evaluated and compared.ResultsFor the bone marrow, the small bowel and the peritoneal space all clinically relevant relative dose parameters (V10-V50) as well as the Dmedian could be significantly reduced with every cranial target volume reduction of 1 cm. For V10 of the peritoneal space the dose could be nearly halved with a 3 cm shortened TV. After TV reduction of 3 cm also for the urinary bladder a significant dose reduction of the Dmedian could be achieved.ConclusionsConsidering the very low recurrence rates in the TME and IMRT era, the distribution patterns of these relapses as well as the relevant side effects of nCRT, we would agree with existing recommendations of reduction of the cranial target volume in nCRT treated rectal cancer patients.

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Radiation dose intensification in pre-operative chemo-radiotherapy for locally advanced rectal cancer

Cited by 31 publications

References 33 publications

Does baseline [18F] FDG-PET/CT correlate with tumor staging, response after neoadjuvant chemoradiotherapy, and prognosis in patients with rectal cancer?

Does baseline [18F] FDG-PET/CT correlate with tumor staging, response after neoadjuvant chemoradiotherapy, and prognosis in patients with rectal cancer?

The Effect of Primary Tumor Radiotherapy in Patients with Unresectable Stage IV Rectal or Rectosigmoid Cancer: A Propensity Score Matching Analysis for Survival.

Dosimetric analysis and comparison of reduced longitudinal cranial margins of VMAT-IMRT of rectal cancer

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