The Impact of Novel Radiation Treatment Techniques on Toxicity and Clinical Outcomes in Rectal Cancer

Hathout, Lara; Williams, Terence M.; Jabbour, Salma K.

doi:10.1007/s11888-017-0351-z

Cited by 8 publications

(5 citation statements)

References 87 publications

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“…Colorectal cancer (CRC) is the third most common cancer worldwide, the second leading cause of cancer deaths in 2016 in the USA and is slightly more common in men. Rectal cancer accounts for one-third of all colorectal cancers and approximately 39,220 new cases of rectal cancer with an estimated 5-year overall survival rate of 65% occur each year [1][2][3][4][5]. Nowadays, nCRT followed by surgical resection is the standard treatment, which is widely used for treatment of locally advanced (cT3, 4 and/or N+) rectal cancer (LARC) [6,7].…”

Section: Introductionmentioning

confidence: 99%

Prediction of Response to Neoadjuvant Chemoradiotherapy by MRI-Based Machine Learning Texture Analysis in Rectal Cancer Patients

Shayesteh

Alikhassi

Farhan

et al. 2019

J Gastrointest Canc

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Introduction Neoadjuvant chemoradiotherapy (nCRT) followed by surgical resection is the standard treatment for locally advanced rectal cancer (LARC). Radiomics can be used as noninvasive biomarker for prediction of response to therapy. The main aim of this study was to evaluate the association of MRI texture features of LARC with nCRT response and the effect of Laplacian of Gaussian (LoG) filter and feature selection algorithm in prediction process improvement. Methods All patients underwent MRI with a 3T clinical scanner, 1 week before nCRT. For each patient, intensity, shape, and texture-based features were derived from MRI images with LoG filter using the IBEX software and without preprocessing. We identified responder from a non-responder group using 9 machine learning classifiers. Then, the effect of preprocessing LoG filters with 0.5, 1 and 1.5 value on these classification algorithms' performance was investigated. Eventually, classification algorithm's results were compared in different feature selection methods. Result Sixty-seven patients with LARC were included in the study. Patients' nCRT responses included 11 patients with Grade 0, 19 with Grade 1, 26 with Grade 2, and 11 with Grade 3 according to AJCC/CAP pathologic grading. In MR Images which were not preprocessed, the best performance was for Ada boost classifier (AUC = 74.8) with T2W MR Images. In T1W MR Images, the best performance was for aba boost classifier (AUC = 78.1) with a σ = 1 preprocessing LoG filter. In T2W MR Images, the best performance was for naive Bayesian network classifier (AUC = 85.1) with a σ = 0.5 preprocessing LoG filter. Also, performance of machine learning models with CfsSubsetEval (CF SUB E) feature selection algorithm was better than others. Conclusion Machine learning can be used as a response predictor model in LARC patients, but its performance should be improved. A preprocessing LoG filter can improve the machine learning methods performance and at the end, the effect of feature selection algorithm on model's performance is clear.

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Section: Introductionmentioning

confidence: 99%

Prediction of Response to Neoadjuvant Chemoradiotherapy by MRI-Based Machine Learning Texture Analysis in Rectal Cancer Patients

Shayesteh

Alikhassi

Farhan

et al. 2019

J Gastrointest Canc

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“…For patients who received radiotherapy as definite therapy, radiotoxicities have to be taken into account ( 11 ). Our current study showed that without any radioprotective agents, especially in Phase I, radiotherapy or combinational treatment rendered 30% grade 2 or above proctitis in low-lying rectal cancer patients, and among them, 7–8% grade 3 proctitis which is in need of surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

The Evolving Strategy of Californium-252 Neutron Intracavitary Brachytherapy in Treating Patients With Low-Lying T2 or T3 Rectal Adenocarcinoma: From Fixed to Individualized Regime With Intrarectal Peritumoral Injection of Amifostine

et al. 2021

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PurposeTo retrospectively and comparatively evaluate the improvement of the efficacy and safety on the addition of 252Cf neutron intracavitary brachytherapy (ICBT), individualized or individualized with intrarectal peritumoral injection of amifostine (IPIA) to external-beam radiotherapy (EBRT) or concurrent chemo-EBRT in 314 patients with T2N0-1 or T3N0-1 low-lying rectal adenocarcinoma.MethodsPhase I: from 2009 to 2011, 157 patients were treated with additional 252Cf neutron ICBT for four fixed fractions with a total dose of 40–45 Gy-eq during the EBRT. Phase II: from 2011 to 2013, 75 patients were treated with individualized neutron ICBT delivered for two to five fractions with a total dose of 26–45 Gy-eq according to the response of tumor after concurrent chemo-EBRT. Phase III: from 2013 to 2014, 82 patients were treated with individualized ICBT protected by pretreatment IPIA.ResultsThe 4-year local control rates for the entire T2 and T3 patients were 69.4, 72.0, and 79.3%, while the 4-year overall survival rates were 63.1, 54.7, and 72.0% (P=0.08), and the 4-year disease-free survival rates were 55.4, 52.0, and 69.5% (P=0.053) in Phases I, II, and III, respectively. The late complication (LAC, ≥G2) rates were 33.8, 26.7, and 15.9%, respectively (P=0.012), and the serious LAC (≥G3) rates were 4.5, 4.2, and 0%, respectively, in Phases I, II, and III.ConclusionConcurrent chemo-EBRT combined with individualized 252Cf neutron ICBT protected by IPIA shows promising efficacy and safety in treating low-lying T2 and T3 rectal adenocarcinoma patients without surgery opportunity or willing.

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“…Future developments may ultimately lead to traditional photon irradiation being replaced with charged particles such as protons or carbon ions, which may have even greater biological effectiveness while maintaining a favourable toxicity profile. At the present time, further clinical studies and access to treatment facilities are required to assess the applicability of these techniques fully.…”

Section: Alternatives To Standard Radiotherapy Strategiesmentioning

confidence: 99%

“…effectiveness while maintaining a favourable toxicity profile. At the present time, further clinical studies and access to treatment facilities are required to assess the applicability of these techniques fully 119,120 .…”

Section: Zerumbonementioning

confidence: 99%

Systematic review of treatment intensification using novel agents for chemoradiotherapy in rectal cancer

Clifford

Govindarajah

Parsons

et al. 2018

British Journal of Surgery

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BackgroundWith the well established shift to neoadjuvant treatment for locally advanced rectal cancer, there is increasing focus on the use of radiosensitizers to improve the efficacy and tolerability of radiotherapy. There currently exist few randomized data exploring novel radiosensitizers to improve response and it is unclear what the clinical endpoints of such trials should be.MethodsA qualitative systematic review was performed according to the PRISMA guidelines using preset search criteria across the PubMed, Cochrane and Scopus databases from 1990 to 2017. Additional results were generated from the reference lists of included papers.ResultsA total of 123 papers were identified, of which 37 were included; a further 60 articles were obtained from additional referencing to give a total of 97 articles. Neoadjuvant radiosensitization for locally advanced rectal cancer using fluoropyrimidine‐based chemotherapy remains the standard of treatment. The oral derivative capecitabine has practical advantages over 5‐fluorouracil, with equal efficacy, but the addition of a second chemotherapeutic agent has yet to show a consistent significant efficacy benefit in randomized clinical assessment. Preclinical and early‐phase trials are progressing with promising novel agents, such as small molecular inhibitors and nanoparticles.ConclusionDespite extensive research and promising preclinical studies, a definite further agent in addition to fluoropyrimidines that consistently improves response rate has yet to be found.

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The Impact of Novel Radiation Treatment Techniques on Toxicity and Clinical Outcomes in Rectal Cancer

Cited by 8 publications

References 87 publications

Prediction of Response to Neoadjuvant Chemoradiotherapy by MRI-Based Machine Learning Texture Analysis in Rectal Cancer Patients

Prediction of Response to Neoadjuvant Chemoradiotherapy by MRI-Based Machine Learning Texture Analysis in Rectal Cancer Patients

The Evolving Strategy of Californium-252 Neutron Intracavitary Brachytherapy in Treating Patients With Low-Lying T2 or T3 Rectal Adenocarcinoma: From Fixed to Individualized Regime With Intrarectal Peritumoral Injection of Amifostine

Systematic review of treatment intensification using novel agents for chemoradiotherapy in rectal cancer

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