Moderate dose escalation with volumetric modulated arc therapy improves outcome in rectal cancer

Stuyck, Cedric; Wegge, M.; Bulens, P.; Joye, Ines; Haustermans, Karin

doi:10.1080/0284186x.2017.1350286

Cited by 11 publications

(4 citation statements)

References 26 publications

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“…As we know, IMRT has the abilities of delivering irradiation precisely to the tumors, and decreasing the dose simultaneously to the adjacent important organs, such as the small intestine, liver and kidneys. The satisfactory safety of IMRT has already been shown in treating locally advanced RC, 22 In our previous works, only 1 of the 21 unresectable CC patient (4.8%) had grade 3 hand-foot syndrome. No grade 4 acute toxicity due to NACRT was seen, neither was grade 3/4 postsurgical complication.…”

Section: Discussionmentioning

confidence: 73%

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Chang¹,

Yu²,

Xiao³

et al. 2018

OTT

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BackgroundThe prognosis of locally unresectable colon cancer (CC) is poor. This prospective observational study aimed to further evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by surgery in these patients.Patients and methodsWe consecutively enrolled patients who were diagnosed with locally unresectable CC from November 2010 to March 2017, and received NACRT followed by surgery. The data of all the patients were collected prospectively. The R0 resection, down-stage and pathologic complete response (pCR) rates were calculated to evaluate the short-term treatment effects. The overall survival (OS) was used to evaluate the long-term outcome. The incidence of NACRT-related acute toxicities and postsurgical complications were used to assess the safety.ResultsA total of 60 patients were eligible for analysis, including 57 (95.0%) patients who attained resectability after NACRT. Among patients managed with surgery, 49 cases (86.0%) achieved R0 resection, and 15 cases (26.3%) achieved pCR. Down T stage was seen in 47 cases (82.5%), and down N stage was seen in 53 cases (93.0%). After a median follow-up time of 26 months, the OS appeared as 76.7%. The most common grade 3/4 NACRT-related toxicity was myelosuppression (incidence, 20.0%). The incidence of grade 3/4 surgery-related complication was 7.0%.ConclusionNACRT might be a safe and effective choice for patients with locally unresectable CC to improve treatment effects, long-term survival and life quality, though further validation is needed.

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Section: Discussionmentioning

confidence: 73%

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Chang¹,

Yu²,

Xiao³

et al. 2018

OTT

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“…IMRT was used in most previous reports of dose-escalated neoadjuvant chemoradiotherapy 15–18,20. It decreased the dose to the bowel, bladder, and femoral head21 and reduced the toxicities22,23 compared with 3D-CRT. In comparison with IMRT and volumetric modulated arc therapy, patients treated with Tomotherapy had lower doses to the bladder and femoral head and better conformity index and homogeneity index 24.…”

Section: Discussionmentioning

confidence: 99%

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

Zhao

Liu

Wang

et al. 2019

CMAR

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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.

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“…83 However, additional studies and a meta-analysis report that IMRT and VMAT result in reduced toxicity versus 3-D conformal radiation therapy. [72][73][74][75][76][77] Modern planning techniques like 3-D conformal radiation therapy and IMRT/VMAT produce plans that are more conformal but less robust to daily variations in setup. This is particularly true of IMRT/VMAT because of the creation of concave dose distributions designed precisely to follow the contour of the target and spare critical structures.…”

Section: What Are the Indications For Neoadjuvant Rt For Operable Recmentioning

confidence: 99%

Radiation Therapy for Rectal Cancer: Executive Summary of an ASTRO Clinical Practice Guideline

Anker

Ashman

et al. 2021

Practical Radiation Oncology

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Moderate dose escalation with volumetric modulated arc therapy improves outcome in rectal cancer

Abstract: Moderate dose escalation with VMAT resulted in superior dose-volume parameters compared to 3D-CRT, translating into lower acute toxicity. Additionally, improved tumor response after VMAT up to 50 Gy might contribute to a higher percentage of patients achieving a complete response.

Cited by 11 publications

References 26 publications

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

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

Radiation Therapy for Rectal Cancer: Executive Summary of an ASTRO Clinical Practice Guideline

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Moderate dose escalation with volumetric modulated arc therapy improves outcome in rectal cancer

Abstract: Moderate dose escalation with VMAT resulted in superior dose-volume parameters compared to 3D-CRT, translating into lower acute toxicity. Additionally, improved tumor response after VMAT up to 50 Gy might contribute to a higher percentage of patients achieving a complete response.

Cited by 11 publications

References 26 publications

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

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

Radiation Therapy for Rectal Cancer: Executive Summary of an ASTRO Clinical Practice Guideline

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