Fecal incontinence and radiation dose on anal sphincter in patients with locally advanced rectal cancer (LARC) treated with preoperative chemoradiotherapy: a retrospective, single-institutional study

Vega, F. Arias de la; Eito, C.; Asin, Gemma; Mora, I.; Cambra, Koldo; Mañeru, F.; Ibáñez, Berta; Arbea, Leire; Viúdez, A.; Hernandez, Irene; Arrarás, Juan Ignacio; Errasti, M.; Barrado, M.; Campo, M.; Visus, I.; Flamarique, S.; Ciga, M. A.

doi:10.1007/s12094-017-1627-0

Cited by 12 publications

(10 citation statements)

References 19 publications

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“…It is recognized that bowel adaptation following LAR usually takes up to 18 months before a certain level of consistency is achieved. 16 Another potential explanation, which requires consideration, is that short-course radiotherapy is more commonly used in older patients, as was the case with the current study population, and that these patients tended to have higher rates of major LARS. Although the LARS score takes into consideration QoL, the LARS score questions are still quantitative.…”

Section: Discussionmentioning

confidence: 85%

“…There is available evidence that suggests radiotherapy related sphincter injury, and the resultant impaired function, is dose dependent. 16 Another potential explanation, which requires consideration, is that short-course radiotherapy is more commonly used in older patients, as was the case with the current study population, and that these patients tended to have higher rates of major LARS. Short-course radiotherapy has been shown to have comparable oncological results to long-course chemoradiotherapy 17 and is often seen to be more advantageous in regional centres, as it allows for more convenient management of patients who may live remotely.…”

Section: Discussionmentioning

confidence: 85%

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Prevalence of low anterior resection syndrome at a regional Australian centre

Croese

Zubair

Lonie

et al. 2018

ANZ Journal of Surgery

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 85%

Prevalence of low anterior resection syndrome at a regional Australian centre

Croese

Zubair

Lonie

et al. 2018

ANZ Journal of Surgery

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“…High grade toxicity of anal incontinence in VMAT treated patients was reduced compared to 3DCRT patients. Arias et al showed that the sphincter function (measured via Wexner score) in patients with LARC treated with preoperative radiochemotherapy was significantly less in those patients with V20 > 0 of the anal sphincters compared to those for which V20 = 0 ( 25 ). Hence dependent on tumor localization and distention, it could be important to reduce radiation dose of the anal sphincters and as well rectal surgery should be performed restricting sphincter function damage considering R0 resection.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Efficacy, Toxicity, and Patient-Reported Outcomes in Rectal Cancer Patients Undergoing Preoperative 3D Conformal Radiotherapy or VMAT

et al. 2017

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BackgroundLocally advanced rectal cancer (LARC) patients are usually treated within a multimodal therapy regime, in which the tumor resection plays the major role. This treatment ideally includes 5-fluorouracile (5FU)-based chemoradiation (CRT) leading to significantly improved local control rates. Local therapy as radiotherapy (RT) is required to be adapted referring to side effects and efficacy. Purpose of this study is the comparison of dosimetric parameters, acute and late toxicity, and quality of life in terms of patient-reported outcome (PRO) in patients treated with VMAT or 3D conformal radiotherapy (3DCRT) for LARC.MethodsPelvic RT for LARC was performed with a prescription dose of 45 Gy in 1.8 Gy per fraction, 50.4 Gy in 1.8 Gy per fraction, or 50 Gy in 2 Gy per fraction. Chemotherapy included 5FU or 5FU/Oxaliplatin or Capecitabine-based RT. Acute and late toxicity were evaluated via National Institute Common Terminology Criteria for Adverse Events version (CTCAE) v4.03 and the Scoring System Late effects of Normal Tissue. Quality of life was established via EORTC QLQCR29.ResultsAfter a median follow-up of 38 months (VMAT) and 78 months (3DCRT) there was no significant difference in progression-free survival (p = 0,85) but a significant difference in overall survival (p = 0.032). Regarding dose–volume parameters, patients treated with VMAT plans had a lower V20 of the bladder than 3DCRT-treated patients (p = 0.004). VMAT plans can also reduce Dmean of the right (p = 0.002) and left (p < 0.001) femoral head. Acute side effects between the VMAT and 3DCRT patients showed no significant difference. But concerning long-term effects, VMAT-treated patients had a significant lower appearance of high grade anal incontinence (p = 0.032). Quality of life (PRO) showed no significant different between the patients except of hair loss and worrying about weight.ConclusionVMAT treatment of LARC in preoperative CRT revealed a reduction of dose to organs at risk (OARs) as bladder and femoral heads. However, no changes in acute and long-term toxicity profiles were detectable. For late toxicity and quality of life data longer follow-up times are required.

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“…In the organ preservation setting, other normal tissue may emerge as more relevant for long term functional outcomes and quality of life. These could include the anal sphincter and pelvic floor muscles [37][38], pelvic bones [39], and vagina [40] or penile bulb. There is very little published data optimising rectal cancer radiotherapy in the organ preservation setting, and basic questions around relevant patient-experienced toxicity endpoints and OARs still need to be addressed.…”

Section: Discussionmentioning

confidence: 99%

Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study

Appelt

Kerkhof

Nyvang

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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a b s t r a c tBackground and purpose: Organ preservation strategies are increasingly being explored for early rectal cancer. This requires revision of target volumes according to disease stage, as well as new guidelines for treatment planning. We conducted an international, multicentre dose planning study to develop robust planning objectives for modern radiotherapy of a novel mesorectal-only target volume, as implemented in the STAR-TReC trial (NCT02945566). Materials and methods: The published literature was used to establish relevant dose levels for organ at risk (OAR) plan optimisation. Ten representative patients with early rectal cancer were identified. Treatment scans had mesorectal target volumes as well as bowel cavity, bladder and femoral heads outlined, and were circulated amongst the three participating institutions. Each institution produced plans for short course (SCRT, 5 Â 5 Gy) and long course (LCRT, 25 Â 2 Gy) treatment, using volumetric modulated arc therapy on different dose planning systems. Optimisation objectives for OARs were established by determining dose metric objectives achievable for !90% of plans. Results: Sixty plans, all fulfilling target coverage criteria, were produced. The planning results and literature review suggested optimisation objectives for SCRT: V 10Gy < 180 cm 3 , V 18Gy < 110 cm 3 , V 23Gy < 85 cm 3 for bowel cavity; V 21Gy < 15% and V 25Gy < 5% for bladder; and V 12.5Gy < 11% for femoral heads. Corresponding objectives for LCRT: V 20Gy < 180 cm 3 , V 30Gy < 130 cm 3 , V 45Gy < 90 cm 3 for bowel cavity; V 35Gy < 22% and V 50Gy < 7% for bladder; and V 25Gy < 15% for femoral heads. Constraints were validated across all three institutions. Conclusion: We utilized a multicentre planning study approach to develop robust planning objectives for mesorectal radiotherapy for early rectal cancer.

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Fecal incontinence and radiation dose on anal sphincter in patients with locally advanced rectal cancer (LARC) treated with preoperative chemoradiotherapy: a retrospective, single-institutional study

Abstract: In order to improve the SF in rectal cancer treated with preoperative radiotherapy/capecitabine followed by conservative surgery, the maximum radiation dose to the AS should be limited, when possible, to <20 Gy.

Cited by 12 publications

References 19 publications

Prevalence of low anterior resection syndrome at a regional Australian centre

Prevalence of low anterior resection syndrome at a regional Australian centre

Comparative Analysis of Efficacy, Toxicity, and Patient-Reported Outcomes in Rectal Cancer Patients Undergoing Preoperative 3D Conformal Radiotherapy or VMAT

Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study

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