Preoperative Capecitabine and Accelerated Intensity-Modulated Radiotherapy in Locally Advanced Rectal Cancer: A Phase II Trial

Ballonoff, Ari; Kavanagh, Brian D.; McCarter, Martin; Kane, Madeleine A.; Pearlman, Nathan W.; Nash, Russell; Shah, Raj J.; Raben, David; Schefter, Tracey E.

doi:10.1097/coc.0b013e318161dbd3

Cited by 51 publications

(30 citation statements)

References 21 publications

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“…Capecitabine is the first of a new class of fluoropyrimidines rationally designed to be taken orally. The efficacy, safety and feasibility for its combination with accelerated intensity-modulated radiotherapy in locally advanced rectal cancer had been proved in Phase II trials [22,23]. In our study, 3D-CAHRT was taken to deliver field-involved re-irradiation and the shrinking field technique was performed after 36 Gy was given in 30 fractions over 3 weeks.…”

Section: Discussionmentioning

confidence: 99%

Accelerated hyperfractionation field-involved re-irradiation combined with concurrent capecitabine chemotherapy for locally recurrent and irresectable rectal cancer

Ds¹,

Jd²,

L³

et al. 2012

BJR

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Objectives: To evaluate the efficacy and treatment-related toxicity of accelerated hyperfractionation field-involved re-irradiation combined with concurrent capecitabine chemotherapy for locally recurrent and irresectable rectal cancer (LRIRC). Methods: 72 patients with LRIRC who underwent the treatment were studied. Threedimensional conformal accelerated hyperfractionation radiotherapy (3D-CAHRT) was performed and the dose was delivered with a schedule of 1.2 Gy twice daily, with an interval of at least 6 h between fractions, 5 days a week. Concurrent capecitabine chemotherapy was administered twice daily. After 36 Gy in 30 fractions over 3 weeks, patients were evaluated to define the resectability of the disease. If resection was not feasible irradiation was resumed until the total dose administered to the tumour reached 51.6-56.4 Gy. Results: Two patients temporarily interrupted concurrent chemoradiation because of Grade IV diarrhoea. The remaining 70 patients completed the planned concurrent chemoradiation. In all patients, the complete response rate was 8.3% and the partial response rate was 51.4%. The overall response rate was 59.7% and clinical benefit rate was 93.1%. Symptomatic responses proved to be obvious and tumour resection was performed in 18 patients. The overall median survival time and median progressionfree survival time were 32 and 17 months, respectively. 3 year overall survival and progression-free survival were 45.12% and 31.19%, respectively. Severely acute toxicities included Grade III-IV diarrhoea and granulocytopenia with 9.7% and 8.3% incidence respectively. Small bowel obstruction was severely late toxicity, and the incidence was 1.4%. Conclusion: Three-dimensional conformal accelerated hyperfractionation fieldinvolved re-irradiation combined with concurrent capecitabine chemotherapy might be an effective and well-tolerated regimen for patients with LRIRC.

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Section: Discussionmentioning

confidence: 99%

Accelerated hyperfractionation field-involved re-irradiation combined with concurrent capecitabine chemotherapy for locally recurrent and irresectable rectal cancer

Ds¹,

Jd²,

L³

et al. 2012

BJR

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“…Intensity-modulated radiotherapy (IMRT) has more recently been recommended as an advanced radiotherapy planning technique to optimise a reduction in the volume of small bowel irradiated [13][14][15]. However, at present there is limited Phase I and II trial data for IMRT in the treatment of locally advanced rectal cancer [16,17], and currently in the UK many centres still use conventional planning techniques for preoperative CRT. Therefore, before advancing to and developing IMRT, we need to evaluate conformal three-dimensional (3D) CT planning.…”

mentioning

confidence: 99%

Comparison of conventional and three-dimensional conformal CT planning techniques for preoperative chemoradiotherapy for locally advanced rectal cancer

Corner

Khimji²,

Tsang³

et al. 2011

BJR

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Objectives:We assessed the impact of three-dimensional (3D) conformal planning vs conventional planning of preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) on small bowel and bladder sparing and in optimising coverage of tumour target volume. Methods: Conformal and conventional plans were created for 50 consecutive patients. The conformal plan delineated a gross tumour volume (GTV), a clinical target volume (CTV) 1 to cover potential subclinical disease spread, a CTV2 to outline the mesorectum and lymph node areas at risk, and a planning target volume (PTV) to cover set-up error and organ movement. The conventional plan was created using digitally reconstructed radiographs (DRRs). Patients were treated with a dose of 45 Gy in 25 fractions with concurrent chemotherapy over 5 weeks. Dose-volume histograms (DVHs) were created and compared for GTV, PTV, small bowel and bladder. The GTV was covered by the conventional plan in all patients. Results: Significant differences were shown for median PTV coverage with conformal planning compared with conventional planning: 99.2% vs 94.2% (range 95.9-100% vs 75.5-100%); p,0.05. The median volume of irradiated small bowel was significantly lower for CT plans at all DVH levels. Median bladder doses did not differ significantly. Conclusion: 3D conformal CT planning is superior to conventional planning in terms of coverage of the tumour volume. It significantly reduces the volume of small bowel irradiated with no decrease in the rate of R0 resection compared with published data, and at the present time should be considered as the standard of care for rectal cancer planning. Chemoradiotherapy (CRT) followed by total mesorectal excision is the standard for care when MRI staging demonstrates threatened surgical margins in locally advanced rectal cancer (LARC) [1,2]. Radiotherapy planning for rectal cancer uses conventional orthogonal simulation with standardised radiation fields based on patterns of loco-regional relapse in relation to pelvic bony anatomy [3]. Three-field conventional orthogonal planning is considered an acceptable technique for planning preoperative CRT and major trials evaluating long-course chemoradiation for rectal cancer have permitted the use of conventional planning within their protocols [4,5]. In recent years, the treatment of rectal cancer has improved through advances in the planning and delivery of radiotherapy as well as improved preoperative imaging with MRI, the development of surgical techniques using total mesorectal excision (TME) and more accurate histopathological reporting [6]. Radiotherapy planning must ensure all clinically and radiologically identifiable disease is encompassed while still minimising the dose to the surrounding organs at risk, particularly the small bowel and bladder. Potential areas of microscopic spread and the appropriate pelvic lymph nodes should also be treated.Preoperative MRI has improved the knowledge of pelvic anatomy and identification of pelvic lymph nodes at risk according to tumour l...

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“…After a careful retrospective anamnesis we cannot exclude the possibility of a perianal fistula antecedents, the patient mentioning the evolution of a perianal small lesion not taken seriously into consideration. Regarding radiotherapy, our option to use the SIB treatment technique was based on previous clinical data from the literature that confirmed the association of this therapeutic approach with high local control and low toxicity rates for locally advanced rectal cancer patients (18,19). Due to the large target volumes, probably a similar target volume dose distribution would have been achieved by using 3D conformal radiotherapy (3D-CRT).…”

Section: Discussionmentioning

confidence: 99%

Synchronous Locally Advanced Rectal Cancer with Clinical Complete Remission and Important Downstaging after Neoadjuvant Radiochemotherapy - Personalised Therapeutic Approach

Georgescu¹,

Géorgescu²,

Bobircă³

et al. 2017

chr

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RezumatIntroducere: În cazul pacienţilor care obţin un răspuns bun după terapie neoadjuvantă, cu downstaging important, sau chiar remisie completă, practica curentă este de a efectua secvenţa chirurgicală în funcţie de evaluarea preterapeutică. În literatură sunt descrise mai multe abordări posibile pentru pacienţii cu răspuns bun după terapie neoadjuvantă, de la exicize endoscopică transanală până la "wait and see". Totuşi, nu există un consens internaţional, iar abordările terapeutice care exclud chirurgia nu sunt susţinute de studii clinice randomizate. Prezentare de caz: Este prezentat cazul unui pacient în vârstă de 63 de ani, care este investigat şi diagnosticat cu neoplasm rectal sincron, la nivelul rectului inferior, invaziv în regiunea perianală şi la nivelul rectului mediu, întins axial între 8 şi 14 cm, stadializarea preterapeutică fiind cT4N2M0. Comisia oncologică decide radiochimioterapie neoadjuvantă. La reevaluare postteraputică se constată remisia completă a formaţiunii rectale inferioare şi leziune ulcerativ infiltrativă remanentă la nivelul rectului mediu. Pacientul refuză în mod categoric colostomia, asumându-şi riscul de recidivă şi solicitând o intervenţie chirugicală cu anastomoză. Se practică o rezecţie rectală joasă TME cu anastomoza colo-rectală

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Preoperative Capecitabine and Accelerated Intensity-Modulated Radiotherapy in Locally Advanced Rectal Cancer: A Phase II Trial

Abstract: Preoperative chemoradiation with capecitabine and SIB-IMRT is well tolerated and results in an encouraging pCR rate for patients with locally advanced rectal cancer.

Cited by 51 publications

References 21 publications

Accelerated hyperfractionation field-involved re-irradiation combined with concurrent capecitabine chemotherapy for locally recurrent and irresectable rectal cancer

Accelerated hyperfractionation field-involved re-irradiation combined with concurrent capecitabine chemotherapy for locally recurrent and irresectable rectal cancer

Comparison of conventional and three-dimensional conformal CT planning techniques for preoperative chemoradiotherapy for locally advanced rectal cancer

Synchronous Locally Advanced Rectal Cancer with Clinical Complete Remission and Important Downstaging after Neoadjuvant Radiochemotherapy - Personalised Therapeutic Approach

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