Treatment Intensification for Locally Advanced Rectal Cancer: Impact on Pathological Complete Response and Outcomes

Tommaso, M. Di; Rosa, Consuelo; Caravatta, L.; Augurio, Antonietta; Borzillo, Valentina; Santo, Sara Di; Perrotti, Francesca; Taraborrelli, Maria; Cianci, Roberta; Innocenti, Paolo; Sebastiano, Pierluigi Di; Colasante, Antonella; Angelucci, Domenico; Basti, M; Sindici, Giulia; Mazzola, Lorenzo; Pizzicannella, G; Bartolomeo, Nicola; Marchioni, Michele; Nicola, Marta Di; Genovesi, Domenico

doi:10.21873/invivo.11896

Cited by 4 publications

(3 citation statements)

References 33 publications

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“…A pCR rate of 26.7%, with TRG1-2 rate of 41.8%, was shown in a dose intensification study of 322 patients with LARC. The 5and 10-year OS, DFS and LC rates were 82.5%±2.5% and 65.5%±3.8%, 81.2%±2.4% and 79.3%±2.9%, 93.1%±1.7% and 90.5%±2.1%, respectively (32). Moreover, an exponential increase in pCR-rate after neoadjuvant radiation dose ≥60 Gy, has been shown by mathematical and clinical dose-response prediction models (pCR=50% with >92 Gy) (6).…”

Section: Discussionmentioning

confidence: 85%

Treatment Volume, Dose Prescription and Delivery Techniques for Dose-intensification in Rectal Cancer: A National Survey

et al. 2021

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Background/Aim: The aim of the study was to investigate boost volume definition, doses, and delivery techniques for rectal cancer dose intensification. Patients and Methods: An online survey was made on 25 items (characteristics, simulation, imaging, volumes, doses, planning and treatment). Results: Thirty-eight radiation oncologists joined the study. Twenty-one delivered long-course radiotherapy with dose intensification. Boost volume was 1985 § These Authors contributed equally to the present study.

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Section: Discussionmentioning

confidence: 85%

Treatment Volume, Dose Prescription and Delivery Techniques for Dose-intensification in Rectal Cancer: A National Survey

et al. 2021

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“…In patients with LARC, the potentiality of increasing doses (more than 60 Gy) of neoadjuvant CRT, without compromising toxicities, is an interesting approach, allowing a pCR increase up to 20.4% (1, 2). Standard doses of 50 Gy compared to dose intensification up to 55 Gy, both associated with fluoropyrimidine-based chemotherapy, can achieve a higher rate of pCR (TRG1-2 of 42.2% versus 59.4%, respectively) (17).…”

Section: Discussionmentioning

confidence: 99%

“…Dose escalation up to 55 Gy associated with fluoropyrimidine chemotherapy obtained a significantly higher tumor regression grade (TRG)1-2 rate of 59.4% (p=0.046) compared to standard doses of 50 Gy with fluoropyrimidine (TRG1-2: 42.2%). Furthermore, tumor response as TRG1-2 was associated with statistically higher rates of 5-and 10-year overall survival (OS) (p=0.001) and disease-free survival (DFS) (p=0.014) (17).…”

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confidence: 99%

DWI-MR and PET-CT Functional Imaging for Boost Tumor Volume Delineation in Neoadjuvant Rectal Cancer Treatment

Rosa

Gasparini²,

Guglielmo³

et al. 2023

In Vivo

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Background/Aim: T2 weighted magnetic resonance (MR) imaging is the gold standard for locally advanced rectal cancer (LARC) staging. The potential benefit of functional imaging, as diffusion-weighted MR (DWI) and positron emission tomography-computed tomography (PET-CT), could be considered for treatment intensification strategies. Dose intensification resulted in better pathological complete response (pCR) rates. This study evaluated the inter-observer agreement between two radiation oncologists, and the difference in gross tumor volume (GTV) delineation in simulation-CT, T2-MR, DWI-MR, and PET-CT in patients with LARC. Patients and Methods: Two radiation oncologists prospectively delineated GTVs of 24 patients on simul-CT (CT GTV ), T2-weighted MR (T2 GTV ), echo planar b1000 DWI (DWI GTV ) and PET-CT (PET GTV ). Observers' agreement was assessed using Dice index. Kruskal-Wallis test assessed differences between methods. Results: Mean CT GTV , T2 GTV , DWI GTV , and PET GTV were 41.3±26.9 cc, 25.9±15.2 cc, 21±14.8 cc, and 37.7±27.7 cc for the first observer, and 42.2±27.9 cc, 27.6±16.9 cc, 19.9±14.9cc, and 34.8±24.3 cc for the second observer, respectively. Mean Dice index was 0.85 for CT GTV , 0.84 for T2 GTV , 0.82 for DWI GTV , and 0.89 for PET GTV , representative of almost perfect agreement. Kruskal-Wallis test showed a statistically significant difference between methods (p=0.009). Dunn test showed there were differences between DWI GTV vs. PET GTV (p=0.040) and DWI GTV vs. CT GTV (p=0.008). Conclusion: DWI resulted in smaller volume delineation compared to CT, T2-MR, and PET-CT functional images. Almost perfect agreements were reported for each imaging modality between two observers. DWI-MR seems to remain the optimal strategy for boost volume delineation for dose escalation in patients with LARC.Standard treatment for locally advanced rectal cancer (LARC) is represented by neoadjuvant chemoradiotherapy (CRT) followed by organ preservation surgery. It is well known that clinical outcomes depend on the results of these treatments, in particular related to pathological complete response (pCR).Response to neoadjuvant CRT is dose-dependent with pCR rates reaching 20.4% using treatment intensification, when dose escalation above 60 Gy are delivered (1). Furthermore, both better dose distribution to the target as well as sparing the adjacent small bowel and other organs at risk (OARs) can be obtained with modern radiotherapy 424

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3.0 T MRI IVIM-DWI for predicting the efficacy of neoadjuvant chemoradiation for locally advanced rectal cancer

Jiang

Wang

et al. 2020

Abdom Radiol

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Purpose The purpose of this study was to determine the diagnostic performance of intravoxel incoherent motion (IVIM) on assessing response to neoadjuvant chemoradiation (nCRT) in patients with Locally Advanced Rectal Cancer (LARC). Methods 50 patients with rectal cancer who underwent magnetic resonance (MR) imaging before and after nCRT, the values of pre-nCRT and post-nCRT IVIM-DWI parameters apparent diffusion coefficient (ADC), diffusion coefficient (D), false diffusion coefficient (D*), and perfusion fraction (f), together with the percentage changes (∆% parametric value) induced by nCRT were calculated. According to the patient's response to nCRT, the patients were divided into pathological complete response (pCR) and non-pCR groups, Good Response (GR) group and Poor Response (PR) group, and the above values were compared between different groups. Univariate and multiple logistic regression analysis were done to investigate the relation between different parameters and patient nCRT. Draw ROC curve according to sensitivity and specificity, and compare its diagnostic efficacy. Results There were no significant differences in the baseline data of 50 patients. After nCRT, the ADC and D values for LARC increased significantly (all p < 0.05). The pCR group (n = 9) had higher preD*, pref, postD*, ∆%ADC and ∆%D values than the non-pCR group (n = 41) (all p < 0.05). The GR group (n = 17) exhibited higher post D, ∆%ADC and ∆%D values than the PR group (n = 33) (all p < 0.05). From the results of Logistic regression analysis found that ∆%ADC and ∆%D were significantly correlated with patients' response to nCRT. Based on ROC analysis, ∆%D had a higher area under the curve value than ∆%ADC (p = 0.009) in discriminating the pCR from non-pCR groups. Conclusions IVIM-DWI technology may be helpful in identifying the pCR and GR patients to nCRT for LARC.

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Treatment Intensification for Locally Advanced Rectal Cancer: Impact on Pathological Complete Response and Outcomes

Cited by 4 publications

References 33 publications

Treatment Volume, Dose Prescription and Delivery Techniques for Dose-intensification in Rectal Cancer: A National Survey

Treatment Volume, Dose Prescription and Delivery Techniques for Dose-intensification in Rectal Cancer: A National Survey

DWI-MR and PET-CT Functional Imaging for Boost Tumor Volume Delineation in Neoadjuvant Rectal Cancer Treatment

3.0 T MRI IVIM-DWI for predicting the efficacy of neoadjuvant chemoradiation for locally advanced rectal cancer

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