BACKGROUND AND PURPOSE: The addition of chemotherapy to preoperative radiotherapy has been established as the standard of care for patients with cT3-4 rectal cancer. As an alternative strategy, we explored intensity-modulated and image-guided radiotherapy (IMRT-IGRT) with a simultaneous integrated boost (SIB) in a prospective phase II study. Here, we report outcome and late toxicity after a median follow-up of 54 months. METHODS AND MATERIALS: A total of 108 patients were treated preoperatively with IMRT-IGRT, delivering a dose of 46 Gy in fractions of 2 Gy. Patients (n=57) displaying an anticipated circumferential resection margin (CRM) of less than 2mm based on magnetic resonance imaging received a SIB to the tumor up to a total dose of 55.2 Gy. RESULTS: The absolute incidence of grade ≥3 late gastrointestinal and urinary toxicity was 9% and 4%, respectively, with a 13% rate of any grade ≥3 late toxicity. The actuarial 5-year local control (LC), progression-free survival (PFS) and overall survival (OS) were 97%, 57%, and 68%. On multivariate analysis, R1 resection and pN2 disease were associated with significantly impaired OS. CONCLUSIONS: The use of preoperative IMRT-IGRT with a SIB resulted in a high 5-year LC rate and non-negligible late toxicity.
BACKGROUND AND PURPOSE: The addition of chemotherapy to preoperative radiotherapy has been established as the standard of care for patients with cT3-4 rectal cancer. As an alternative strategy, we explored intensity-modulated and image-guided radiotherapy (IMRT-IGRT) with a simultaneous integrated boost (SIB) in a prospective phase II study. Here, we report outcome and late toxicity after a median follow-up of 54 months. METHODS AND MATERIALS: A total of 108 patients were treated preoperatively with IMRT-IGRT, delivering a dose of 46 Gy in fractions of 2 Gy. Patients (n=57) displaying an anticipated circumferential resection margin (CRM) of less than 2mm based on magnetic resonance imaging received a SIB to the tumor up to a total dose of 55.2 Gy. RESULTS: The absolute incidence of grade ≥3 late gastrointestinal and urinary toxicity was 9% and 4%, respectively, with a 13% rate of any grade ≥3 late toxicity. The actuarial 5-year local control (LC), progression-free survival (PFS) and overall survival (OS) were 97%, 57%, and 68%. On multivariate analysis, R1 resection and pN2 disease were associated with significantly impaired OS. CONCLUSIONS: The use of preoperative IMRT-IGRT with a SIB resulted in a high 5-year LC rate and non-negligible late toxicity.
Authors: Bong Kyung Bae; Min Kyu Kang; Jae-Chul Kim; Mi Young Kim; Gyu-Seog Choi; Jong Gwang Kim; Byung Woog Kang; Hye Jin Kim; Soo Yeun Park Journal: Radiat Oncol J Date: 2017-09-29
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: Jillian R Gunther; Awalpreet S Chadha; Ui Sup Shin; In Ja Park; Kiran V Kattepogu; Jonathan D Grant; David C Weksberg; Cathy Eng; Scott E Kopetz; Prajnan Das; Marc E Delclos; Harmeet Kaur; Dipen M Maru; John M Skibber; Miguel A Rodriguez-Bigas; Y Nancy You; Sunil Krishnan; George J Chang Journal: Adv Radiat Oncol Date: 2017-04-12