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Radiother Oncol. 2014 Jan;110(1):155-9. doi: 10.1016/j.radonc.2013.10.026. Epub 2013 Nov 12.

Preoperative intensity-modulated and image-guided radiotherapy with a simultaneous integrated boost in locally advanced rectal cancer: report on late toxicity and outcome.

Author information

1
Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Belgium. Electronic address: benedikt.engels@gmail.com.
2
Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Belgium.
3
Department of Gastroenterology, UZ Brussel, Vrije Universiteit Brussel, Belgium.

Abstract

BACKGROUND AND PURPOSE:

The addition of chemotherapy to preoperative radiotherapy has been established as the standard of care for patients with cT3-4 rectal cancer. As an alternative strategy, we explored intensity-modulated and image-guided radiotherapy (IMRT-IGRT) with a simultaneous integrated boost (SIB) in a prospective phase II study. Here, we report outcome and late toxicity after a median follow-up of 54 months.

METHODS AND MATERIALS:

A total of 108 patients were treated preoperatively with IMRT-IGRT, delivering a dose of 46 Gy in fractions of 2 Gy. Patients (n=57) displaying an anticipated circumferential resection margin (CRM) of less than 2mm based on magnetic resonance imaging received a SIB to the tumor up to a total dose of 55.2 Gy.

RESULTS:

The absolute incidence of grade ≥3 late gastrointestinal and urinary toxicity was 9% and 4%, respectively, with a 13% rate of any grade ≥3 late toxicity. The actuarial 5-year local control (LC), progression-free survival (PFS) and overall survival (OS) were 97%, 57%, and 68%. On multivariate analysis, R1 resection and pN2 disease were associated with significantly impaired OS.

CONCLUSIONS:

The use of preoperative IMRT-IGRT with a SIB resulted in a high 5-year LC rate and non-negligible late toxicity.

KEYWORDS:

Helical tomotherapy; Image-guided radiotherapy; Intensity-modulated radiotherapy; Preoperative radiotherapy; Rectal cancer; Simultaneous integrated boost

PMID:
24239243
DOI:
10.1016/j.radonc.2013.10.026
[Indexed for MEDLINE]

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