Joanna Socha1, Lucyna Pietrzak2, Anna Zawadzka3, Anna Paciorkiewicz3, Anna Krupa2, Krzysztof Bujko2. 1. Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland; Department of Radiotherapy, Regional Oncology Center, Czestochowa, Poland. Electronic address: sochajoanna@wp.pl. 2. Department of Radiotherapy I, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland. 3. Medical Physics Department, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
Abstract
BACKGROUND: There are no guidelines on clinical target volume (CTV) delineation for cT2 rectal cancer treated with organ preservation. MATERIALS AND METHODS: A systematic review and meta-analysis were performed to determine the extent of distal mesorectal (DMS) and distal intramural spread (DIS), the risk of lateral lymph node (LLN) metastases in pT2 tumours, and regional recurrence pattern after organ preservation. RESULTS: The rate of DMS > 1 cm was 1.9% (95% CI: 0.4-5.4%), maximum extent: 1.3 cm. The rate of DIS > 0.5 cm was 4.7% (95% CI: 1.3-11.5%), maximum extent: 0.8 cm. The rate of LLN metastases was 8.2% (95% CI: 6.7-9.9%) for tumours below or at peritoneal reflexion and 0% for higher tumours. Regional nodal recurrences alone were recorded in 1.0% (95% CI: 0.5-1.7%) of patients after watch-and-wait and in 2.1% (95% CI: 1.2-3.4%) after preoperative radiotherapy and local excision. Thus, the following rules for CTV delineation are proposed: caudal border 1.5 cm from the tumour to account for DMS or 1 cm to account for DIS, whichever is more caudal; cranial border at S2/S3 interspace; inclusion of LLN for tumours at or below peritoneal reflexion. A planning study was performed in eight patients to compare dose-volume parameters obtained using these rules to that obtained using current guidelines for advanced cancers. The proposed rules led to a mean 18% relative reduction of planning target volume, which resulted in better sparing of organs-at-risk. CONCLUSION: This meta-analysis suggests a smaller CTV for cT2 tumours than the current guidelines designed for advanced cancers.
BACKGROUND: There are no guidelines on clinical target volume (CTV) delineation for cT2rectal cancer treated with organ preservation. MATERIALS AND METHODS: A systematic review and meta-analysis were performed to determine the extent of distal mesorectal (DMS) and distal intramural spread (DIS), the risk of lateral lymph node (LLN) metastases in pT2 tumours, and regional recurrence pattern after organ preservation. RESULTS: The rate of DMS > 1 cm was 1.9% (95% CI: 0.4-5.4%), maximum extent: 1.3 cm. The rate of DIS > 0.5 cm was 4.7% (95% CI: 1.3-11.5%), maximum extent: 0.8 cm. The rate of LLN metastases was 8.2% (95% CI: 6.7-9.9%) for tumours below or at peritoneal reflexion and 0% for higher tumours. Regional nodal recurrences alone were recorded in 1.0% (95% CI: 0.5-1.7%) of patients after watch-and-wait and in 2.1% (95% CI: 1.2-3.4%) after preoperative radiotherapy and local excision. Thus, the following rules for CTV delineation are proposed: caudal border 1.5 cm from the tumour to account for DMS or 1 cm to account for DIS, whichever is more caudal; cranial border at S2/S3 interspace; inclusion of LLN for tumours at or below peritoneal reflexion. A planning study was performed in eight patients to compare dose-volume parameters obtained using these rules to that obtained using current guidelines for advanced cancers. The proposed rules led to a mean 18% relative reduction of planning target volume, which resulted in better sparing of organs-at-risk. CONCLUSION: This meta-analysis suggests a smaller CTV for cT2tumours than the current guidelines designed for advanced cancers.
Authors: A A J Grüter; A S van Lieshout; S E van Oostendorp; J C F Ket; M Tenhagen; F C den Boer; R Hompes; P J Tanis; J B Tuynman Journal: Tech Coloproctol Date: 2022-08-29 Impact factor: 3.699
Authors: Femke P Peters; Mark T W Teo; Ane L Appelt; Simon Bach; Gunnar Baatrup; Johannes H W de Wilt; Camilla Jensenius Kronborg; Karen-Lise Garm Spindler; Corrie A M Marijnen; David Sebag-Montefiore Journal: Clin Transl Radiat Oncol Date: 2020-02-04