Stereotactic MR-guided adaptive radiotherapy (SMART) for primary rectal cancer: evaluation of early toxicity and pathological response.

Autor:	Castelluccia A; Radiation Oncology, Perrino Hospital, Brindisi, Italy., Marchesano D; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy., Grimaldi G; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy., Annessi I; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy., Bianciardi F; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy.; Radiation Oncology, UPMC Hillman Cancer Center San Pietro FBF, Rome, Italy., Borrazzo C; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy., Dipalma A; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy., El Gawhary R; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy., Masi M; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy., Rago M; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy., Valentino M; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy., Verna L; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy., Portaluri M; Radiation Oncology, Perrino Hospital, Brindisi, Italy., Gentile P; Radiation Oncology, Provincia Religiosa di San Pietro Fatebenefratelli, Roma, Italy.; Radiation Oncology, UPMC Hillman Cancer Center San Pietro FBF, Rome, Italy.
Jazyk:	angličtina
Zdroj:	Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology [Rep Pract Oncol Radiother] 2023 Aug 28; Vol. 28 (4), pp. 437-444. Date of Electronic Publication: 2023 Aug 28 (Print Publication: 2023).
DOI:	10.5603/RPOR.a2023.0051
Abstrakt:	Background: The purpose of this study is to measure the effects of stereotactic MR-guided adaptive radiotherapy (SMART) for rectal cancer patients in terms of early toxicity and pathological response. Materials and Methods: For this prospective pilot study, patients diagnosed with locally advanced rectal cancer (LARC) with positive lymph node clinical staging underwent SMART on rectal lesion and mesorectum using hybrid MR-Linac (MRIdian ViewRay). Dose prescription at 80% isodose for the rectal lesion and mesorectum was 40 Gy (8 Gy/fr) and 25 Gy (5 Gy/fr), respectively, delivered on 5 days (3 fr/week). Response assessment by MRI was performed 3 weeks after SMART, then patients fit for surgery underwent total mesorectal excision. Primary endpoint was evaluation of adverse effect of radiotherapy. Secondary endpoint was pathological complete response rate. Early toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Results: From October 2020 to January 2022, twenty patients underwent rectal SMART. No grade 3-5 toxicity was recorded. Twelve patients were eligible for total mesorectal excision (TME). Mean interval between the completion of SMART and surgery was 4 weeks. Pathological downstaging occurred in all patients; rate of pathological complete response (pCR) was 17%. pCR occurred with a prolonged time to surgery (> 7 weeks). Conclusion: To our knowledge, this is the first study to use stereotactic radiotherapy for primary rectal cancer. SMART for rectal cancer is well tolerated and effective in terms of tumor regression, especially if followed by delayed surgery. Competing Interests: Conflict of interest None declared. (© 2023 Greater Poland Cancer Centre.)
Databáze:	MEDLINE
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