<p>Concomitant dose escalation with image&ndash;guided Tomotherapy in locally advanced mid&ndash;low rectal cancer: a single-center study</p>

Abstract

Purpose The purpose of this study was to evaluate the efficacy and toxicity of concomitant dose-escalated Tomotherapy in locally advanced mid–low rectal cancer. Patients and methods Patients with locally advanced (T3/T4 or N+), low–mid (≤10 cm from anal verge) rectal carcinoma treated with neoadjuvant chemoradiotherapy followed by surgery between May 2012 and October 2017 in Peking Union Medical College Hospital were included in this study. A dose of 45/50 Gy in 25 fractions was delivered to the pelvis with Tomotherapy, and 55 Gy was prescribed for the primary tumor with a simultaneous, integrated boost. Megavolt computed tomography was performed before every delivery. The concurrent chemotherapy regimen included capecitabine alone and XELOX. Results A total of 141 patients were enrolled; 129 patients (91.5%) had stage cT3 or cT4, and 121 patients (85.8%) had positive lymph nodes. The location of the tumors was in the lower rectum in 88 patients (62.4%). After neoadjuvant chemoradiotherapy, 113 patients (80.1%) underwent sphincter-preserving resection. Downstaging was observed in 121 patients (85.8%), including 80 patients (56.7%) with T downstaging and 101 patients (83.5%) with N downstaging. Thirty-two patients (22.7%) obtained pathological complete response (pCR). The median follow-up was 38.5 months (range, 9.3–73.6 months). Only 36 patients (25.5%) experienced treatment failure, including distant metastasis in 29 patients (20.6%) and pelvic recurrent in 7 patients (5.0%). The estimated 5-year overall survival (OS), disease-free survival (DFS), and local control (LC) rates of patients were 75.1%, 70.9%, and 95.5%, respectively. pCR was an independent prognostic factor for DFS (HR 0.13, 95% CI: 0.02–0.93, P = 0.043), but it did not improve OS or LC. Grade 3 or greater acute leukopenia and diarrhea rates were 5.7% and 7.8%, respectively, and 15 patients (10.6%) developed postoperative complications. Conclusion This study indicates that neoadjuvant, image-guided Tomotherapy with 55 Gy boosted to the primary tumor was well tolerated and resulted in high rates of sphincter-preserving surgery, pCR, LC, and DFS for locally advanced rectal cancer.

Neoadjuvant chemoradiotherapy or radiotherapy in patients aged 75 years or older with locally advanced rectal cancer

“…These results were quite comparable to the previous studies regarding elderly patients [12,[20][21][22]29]. Notably, the oncologic outcomes of our study were not inferior than younger patients in other studies [2,15,21]. In the study of FFCD 9203 [2], the reported 5-year progression free survival (PFS) and local recurrence rate (LRR) were 59.4% and 8.1%.…”

“…In our study, nine patients (16.1%) developed G3/4 neoadjuvant treatment related toxicities, which was comparable with the above studies. Compared with our previous report [15] which included patients with a median age of 59 years (range: 50-67 years), patients in the present study also experienced more G3+ toxicities. Based on these findings, the incidence of neoadjuvant treatment related toxicity in elderly patients with LARC is indeed higher than that in younger patients, but it is quite acceptable.…”

“…The rate of pCR is an important factor for assessing the effect of neoadjuvant chemoradiotherapy and it is also related with improved survival outcomes [15]. The pCR rate is significantly influenced by the escalated dose to primary tumor.…”

“…As described in our previous study [15], all eligible patients received pelvic irradiation with 3 dimensional conformal radiotherapy (3D-CRT) or intensity modulated radiotherapy (IMRT). Clinical target volume (CTV) included the complete mesorectum and pelvic lymph node region (presacral, internal iliac and obturator lymph node).…”

Neoadjuvant chemoradiotherapy followed by surgery benefits patients aged 75 years or older with locally advanced rectal cancer

“…As described in our previous study [15], all eligible patients received pelvic irradiation with 3 dimensional conformal radiotherapy (3D-CRT) or intensity modulated radiotherapy (IMRT). Clinical…”