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

Dapper, Hendrik; Oechsner, Markus; Münch, Stefan; Borm, Kai Joachim; Peeken, Jan C.; Mayinger, Michael; Combs, Stephanie E.; Habermehl, Daniel

doi:10.1186/s13014-018-1120-0

Cited by 4 publications

(4 citation statements)

References 35 publications

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“…Initially, we analyzed the studies (including the studies with significant differences in baseline data, such as Lin, Yeom, Lee study) with RevMan 5.0 and 2-DFS in the W&W group was better than that in the TME group. The specific information is shown in the supplementary material 14 [ 43 ]. We hypothesized that the large difference in the baseline data and the incomplete information of Lin, Yeom, Lee, and other studies could affect the results of the research, so we only included studies with consistent baseline data.…”

Section: Outcome Resultsmentioning

confidence: 99%

A meta-analysis of the watch-and-wait strategy versus total mesorectal excision for rectal cancer exhibiting complete clinical response after neoadjuvant chemoradiotherapy

Lü

Jiao

et al. 2021

World J Surg Onc

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Background Some clinical researchers have reported that patients with cCR (clinical complete response) status after neoadjuvant chemoradiotherapy (nCRT) could adopt the watch-and-wait (W&W) strategy. Compared with total mesorectal excision (TME) surgery, the W&W strategy could achieve a similar overall survival. Could the W&W strategy replace TME surgery as the main treatment option for the cCR patients? By using the meta-analysis method, we evaluated the safety and efficacy of the W&W strategy and TME surgery for rectal cancer exhibiting cCR after nCRT. Methods We evaluated two treatment strategies for rectal cancer with cCR after nCRT up to July 2021 by searching the Cochrane Library, PubMed, Wanfang, and China National Knowledge Infrastructure (CNKI) databases. Clinical data for primary outcomes (local recurrence, cancer-related death and distant metastasis), and secondary outcomes (disease-free survival (DFS) and overall survival (OS)) were collected to evaluate the efficacy and safety in the two groups. Results We included nine studies with 818 patients in the meta-analysis, and there were five moderate-quality studies and four high-quality studies. A total of 339 patients were in the W&W group and 479 patients were in the TME group. The local recurrence rate in the W&W group was greater than that in the TME group in the fixed-effects model (OR 8.54, 95% CI 3.52 to 20.71, P < 0.001). The results of other outcomes were similar in the two groups. Conclusion The local recurrence rate of the W&W group was greater than that in the TME group, but other results were similar in the two groups. With the help of physical examination and salvage therapy, the W&W strategy could achieve similar treatment effects with the TME approach. Trial registration Protocol registration number: CRD42021244032.

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Section: Outcome Resultsmentioning

confidence: 99%

A meta-analysis of the watch-and-wait strategy versus total mesorectal excision for rectal cancer exhibiting complete clinical response after neoadjuvant chemoradiotherapy

Lü

Jiao

et al. 2021

World J Surg Onc

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“…Planning target volume (PTV) margins up to 31 mm have been proposed which results in large volumes that receive irradiation [8][9][10]. For rectal cancer patients it is known that margin reduction of the PTV and reducing the amount of organs at risk (OAR) within these volumes has the potential to lower toxicity rates [10][11][12][13][14][15].…”

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confidence: 99%

Online adaptive MR-guided radiotherapy for rectal cancer; feasibility of the workflow on a 1.5T MR-linac: clinical implementation and initial experience

Intven

Otterloo

Mook

et al. 2021

Radiotherapy and Oncology

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Background and purpose: Daily online adaptation of the clinical target volume (CTV) using MR-guided radiotherapy enables margin reduction of the planning target volume (PTV). This study describes the implementation and initial experience of MR-guided radiotherapy on the 1.5T MR-linac and evaluates treatment time, patient compliance, and target coverage, including an initial assessment of margin reduction. Materials and methods: Patients were treated on a 1.5T MR-linac (7MV, FFF). At each fraction a 3D T2 weighted (T2w) MR-sequence was acquired on which the CTV was adapted after a deformable registration of the contours from the pre-planning CT scan. Based on the new contours a full online replanning was done after which a new 3D T2w MR-sequence was acquired for position verification. A 5 field Intensity Modulated Radiotherapy (IMRT) plan was delivered. Results: Forty-three patients with rectal cancer were treated with 25 Gy in 5 fractions of which 18 with reduced margins. In total, 204 of 215 fractions were delivered on the MR-linac all of which obtained a clinically acceptable treatment plan. Median in-room time per fraction was 48 min (interquartile range 8). No fractions were canceled or interrupted because of patient intolerance. CTV coverage after margin reduction was good on all post-treatment scans but one due to passing gas. Conclusion: MR-guided radiotherapy using daily full online recontouring and replanning on a 1.5T MRlinac for rectal cancer is feasible and currently takes about 48 min per fraction.

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“…Особливе місце для планування обсягів променевого впливу займає передпроменева підготовка хворих до проведення променевої терапії (ПТ) [1][2][3][4]. Застосування неоад'ювантної променевої терапії у варіантах без та з потенціюванням, що базується на використанні фторпіримідинів як радіосенсибілізатора, з наступною радикальною операцією в обсязі тотальної мезоректумектомії та ад'ювантною хіміотерапією можна назвати сучасним стандартом лікування хворих з місцево розповсюдженим раком прямої кишки (РПК) [2,[5][6][7].…”

Section: вступunclassified

“…Проте після оперативного втручання у хворих яким виконувалась неоад'ювантна променева терапія, ризик розвитку післяопераційних ускладнень значно збільшується. Найчастіше виникають такі ускладнення як тривала дисфункція сечовидільної системи, статевих органів та анальних сфінктерів, що в свою чергу супроводжується зниженням якості життя цієї групи хворих [4,6,8 Нами проведено дисперсійний аналіз із повторними вимірами відстані між дистальною межею пухлини та анокутанною лінією, який визначив статистично значущий вплив курсу неоадьювантної ХПТ та ПТ на параметри первинної пухлини, що описують її регресію (збільшення відстані між дистальною межею пухлини та анокутанною лінією, а також скорочення протяжності пухлини) (табл. 1).…”

Section: вступunclassified

Topometric Preparation and Planning of Neoadjuvant Radiotherapy in the Complex Treatment of Rectal Cancer

Luc¹

2022

Modern Medical Technology

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Objective(s). To evaluate the effectiveness of the use of topometry during neoadjuvant radiation therapy in the complex treatment of rectal cancer. Methods. The results of treatment of 113 patients with locally advanced rectal cancer (cT3c-4N1-2M0) were analyzed. The patients were divided into two groups: the first (main) group included 57 patients who received only a course of neoadjuvant radiation therapy as part of the neoadjuvant stage of treatment. The second group (control group) included 56 patients who underwent a course of radiation therapy with capecitabine potentiation. Topometric preparation, contouring of irradiated volumes, critical structures and radiation treatment of all patients included in the study were carried out according to standard principles and started 5 days before its implementation. Results. When comparing the results of MRI performed before the beginning and after the end of the radiation therapy course in 102 (90.2%) of 113, a positive trend was noted in the form of a decrease in the length of the tumor itself and an increase in the distance between the tumor and the anal edge, p=0.0001. No statistically significant differences were found when evaluating the influence of criteria of intragroup effects on the reduction of tumor length when choosing fractionation modes. Conclusions. In 52 (91.2%) patients of the main group and 51 (911%) of the control group had a positive CRM status. Analysis of CRM status in patients before and after the end of the course of neoadjuvant radiation therapy showed positive dynamics, both in the main and in the control group (p<0.000). After a prolonged course of neoadjuvant radiation therapy, the number of patients with a positive CRM status decreased to 17 (30%) in the main group and 19 (34%) in the control group (p<0.000). According to the MRI results performed before and after the course of neoadjuvant radiation therapy in 102 (90.2%) out of 113, positive dynamics were noted in the form of a decrease in the length of the tumor itself and an increase in the distance between the tumor and the anal edge, p=0, 0001.

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

Cited by 4 publications

References 35 publications

A meta-analysis of the watch-and-wait strategy versus total mesorectal excision for rectal cancer exhibiting complete clinical response after neoadjuvant chemoradiotherapy

A meta-analysis of the watch-and-wait strategy versus total mesorectal excision for rectal cancer exhibiting complete clinical response after neoadjuvant chemoradiotherapy

Online adaptive MR-guided radiotherapy for rectal cancer; feasibility of the workflow on a 1.5T MR-linac: clinical implementation and initial experience

Topometric Preparation and Planning of Neoadjuvant Radiotherapy in the Complex Treatment of Rectal Cancer

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