Feasibility of an adaptive strategy in preoperative radiochemotherapy for rectal cancer with image-guided tomotherapy: boosting the dose to the shrinking tumor
| Autor: | Elena Orsenigo, Najla Slim, Monica Ronzoni, Saverio Di Palo, Francesco De Cobelli, Vincenzo Ricci, Claudio Fiorino, Paola De Nardi, Nadia Di Muzio, Carlo Staudacher, Sara Broggi, Nicola A. Iacovelli, Andrea Tamburini, Paolo Passoni, Claudio Losio, Riccardo Calandrino |
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| Přispěvatelé: | Passoni, P, Fiorino, C, Slim, N, Ronzoni, M, Ricci, V, Di Palo, S, De Nardi, P, Orsenigo, E, Tamburini, A, DE COBELLI, Francesco, Losio, C, Iacovelli, Na, Broggi, S, Staudacher, Carlo, Calandrino, R, Di Muzio, N. |
| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Cancer Research Neoplasm Residual Organoplatinum Compounds Colorectal cancer medicine.medical_treatment Rectum Tomotherapy Antineoplastic Combined Chemotherapy Protocols Medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Aged Tumor Regression Grade Chemotherapy Radiation business.industry Rectal Neoplasms Remission Induction Chemoradiotherapy Middle Aged medicine.disease Magnetic Resonance Imaging Oxaliplatin Tumor Burden Radiation therapy medicine.anatomical_structure Oncology Concomitant Linear Models Feasibility Studies Female Dose Fractionation Radiation Fluorouracil business Nuclear medicine Tomography X-Ray Computed medicine.drug Radiotherapy Image-Guided |
| Zdroj: | International journal of radiation oncology, biology, physics. 87(1) |
| ISSN: | 1879-355X |
| Popis: | Purpose To investigate the feasibility of preoperative adaptive radiochemotherapy by delivering a concomitant boost to the residual tumor during the last 6 fractions of treatment. Methods and Materials Twenty-five patients with T3/T4N0 or N+ rectal cancer were enrolled. Concomitant chemotherapy consisted of oxaliplatin 100 mg/m 2 on days −14, 0, and +14, and 5-fluorouracil 200 mg/m 2 /d from day −14 to the end of radiation therapy (day 0 is the start of radiation therapy). Radiation therapy consisted of 41.4 Gy in 18 fractions (2.3 Gy per fraction) with Tomotherapy to the tumor and regional lymph nodes (planning target volume, PTV) defined on simulation CT and MRI. After 9 fractions simulation CT and MRI were repeated for the planning of the adaptive phase: PTV adapt was generated by adding a 5-mm margin to the residual tumor. In the last 6 fractions a boost of 3.0 Gy per fraction (in total 45.6 Gy in 18 fractions) was delivered to PTV adapt while concomitantly delivering 2.3 Gy per fraction to PTV outside PTV adapt . Results Three patients experienced grade 3 gastrointestinal toxicity; 2 of 3 showed toxicity before the adaptive phase. Full dose of radiation therapy, oxaliplatin, and 5-fluorouracil was delivered in 96%, 96%, and 88% of patients, respectively. Two patients with clinical complete response (cCR) refused surgery and were still cCR at 17 and 29 months. For the remaining 23 resected patients, 15 of 23 (65%) showed tumor regression grade 3 response, and 7 of 23 (30%) had pathologic complete response; 8 (35%) and 12 (52%) tumor regression grade 3 patients had ≤5% and 10% residual viable cells, respectively. Conclusions An adaptive boost strategy is feasible, with an acceptable grade 3 gastrointestinal toxicity rate and a very encouraging tumor response rate. The results suggest that there should still be room for further dose escalation of the residual tumor with the aim of increasing pathologic complete response and/or cCR rates. |
| Databáze: | OpenAIRE |
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