PURPOSE: The addition of concomitant chemotherapy to preoperative radiotherapy is considered the standard of care for patients with cT3-4 rectal cancer. The combined treatment modality increases the complete response rate and local control (LC), but has no impact on survival or the incidence of distant metastases. In addition, it is associated with considerable toxicity. As an alternative strategy, we explored prospectively, preoperative helical tomotherapy with a simultaneous integrated boost (SIB). METHODS AND MATERIALS: A total of 108 patients were treated with intensity-modulated and image-guided radiotherapy using the Tomotherapy Hi-Art II system. A dose of 46 Gy, in daily fractions of 2 Gy, was delivered to the mesorectum and draining lymph nodes, without concomitant chemotherapy. Patients with an anticipated circumferential resection margin (CRM) of less than 2 mm, based on magnetic resonance imaging, received a SIB to the tumor up to a total dose of 55.2 Gy. Acute and late side effects were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. RESULTS: A total of 102 patients presented with cT3-4 tumors; 57 patients entered the boost group and 51 the no-boost group. One patient in the no-boost group developed a radio-hypersensitivity reaction, resulting in a complete tumor remission, a Grade 3 acute and Grade 5 late enteritis. No other Grade ≥3 acute toxicities occurred. With a median follow-up of 32 months, Grade ≥3 late gastrointestinal and urinary toxicity were observed in 6% and 4% of the patients, respectively. The actuarial 2-year LC, progression-free survival and overall survival were 98%, 79%, and 93%. CONCLUSIONS: Preoperative helical tomotherapy displays a favorable acute toxicity profile in patients with cT3-4 rectal cancer. A SIB can be safely administered in patients with a narrow CRM and resulted in a promising LC.
PURPOSE: The addition of concomitant chemotherapy to preoperative radiotherapy is considered the standard of care for patients with cT3-4rectal cancer. The combined treatment modality increases the complete response rate and local control (LC), but has no impact on survival or the incidence of distant metastases. In addition, it is associated with considerable toxicity. As an alternative strategy, we explored prospectively, preoperative helical tomotherapy with a simultaneous integrated boost (SIB). METHODS AND MATERIALS: A total of 108 patients were treated with intensity-modulated and image-guided radiotherapy using the Tomotherapy Hi-Art II system. A dose of 46 Gy, in daily fractions of 2 Gy, was delivered to the mesorectum and draining lymph nodes, without concomitant chemotherapy. Patients with an anticipated circumferential resection margin (CRM) of less than 2 mm, based on magnetic resonance imaging, received a SIB to the tumor up to a total dose of 55.2 Gy. Acute and late side effects were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. RESULTS: A total of 102 patients presented with cT3-4tumors; 57 patients entered the boost group and 51 the no-boost group. One patient in the no-boost group developed a radio-hypersensitivity reaction, resulting in a complete tumor remission, a Grade 3 acute and Grade 5 late enteritis. No other Grade ≥3 acute toxicities occurred. With a median follow-up of 32 months, Grade ≥3 late gastrointestinal and urinary toxicity were observed in 6% and 4% of the patients, respectively. The actuarial 2-year LC, progression-free survival and overall survival were 98%, 79%, and 93%. CONCLUSIONS: Preoperative helical tomotherapy displays a favorable acute toxicity profile in patients with cT3-4rectal cancer. A SIB can be safely administered in patients with a narrow CRM and resulted in a promising LC.
Authors: Vérane Achard; Frederic Ris; Michel Rouzaud; Giacomo Puppa; Nicolas C Buchs; Thomas De Perrot; Thibaud Koessler; Cristina Picardi; Thomas Zilli Journal: Br J Radiol Date: 2021-01-22 Impact factor: 3.039
Authors: Hui Wang; Soumaya Bouzakoura; Sven de Mey; Heng Jiang; Kalun Law; Inès Dufait; Cyril Corbet; Valeri Verovski; Thierry Gevaert; Olivier Feron; Dirk Van den Berge; Guy Storme; Mark De Ridder Journal: Oncotarget Date: 2017-05-30
Authors: Nam P Nguyen; Misty Ceizyk; Jacqueline Vock; Paul Vos; Alexander Chi; Vincent Vinh-Hung; Judy Pugh; Rihan Khan; Christina Truong; Gabby Albala; Angela Locke; Ulf Karlsson; Steve Gelumbauskas; Lexie Smith-Raymond Journal: PLoS One Date: 2013-08-13 Impact factor: 3.240