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Intensity-Modulated Radiotherapy With a Simultaneous Integrated Boost in Rectal Cancer.

R Owens1, S Mukherjee2, S Padmanaban3

  • 1Department of Oncology, Oxford University Hospitals Trust, Oxford, UK.

Clinical Oncology (Royal College of Radiologists (Great Britain))
|August 1, 2019
PubMed
Summary
This summary is machine-generated.

Higher radiotherapy doses improve rectal cancer response. This study found intensity-modulated radiotherapy (IMRT) with a simultaneous integrated boost (SIB) showed acceptable toxicity and promising tumor regression, supporting its adoption.

Keywords:
Complete responseconstraintsdose escalationintensity-modulated radiotherapyrectal cancersimultaneous integrated boost

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Area of Science:

  • Radiation Oncology
  • Rectal Cancer Treatment
  • Clinical Trials

Background:

  • Dose-response relationships indicate higher radiotherapy doses enhance complete response rates in rectal cancer.
  • The EXPERT trial established a standard dose and fractionation (45 Gy pelvis, 9 Gy boost) for maximizing complete response.
  • Intensity-modulated radiotherapy (IMRT) with a simultaneous integrated boost (SIB) allows for delivering biologically equivalent doses (BED5) in selected rectal cancer patients.

Purpose of the Study:

  • To evaluate the toxicity profile of an IMRT/SIB protocol delivering a biologically equivalent dose for rectal cancer.
  • To assess the appropriateness of RTOG 0822 dose constraints for this IMRT/SIB approach.
  • To determine the treatment response using magnetic resonance tumour regression grade (mrTRG).

Main Methods:

  • Retrospective analysis of 71 rectal cancer patients treated with IMRT/SIB and capecitabine chemotherapy.
  • Collection of treatment details and acute toxicity data.
  • Review of baseline and post-treatment MRI scans by a gastrointestinal radiologist to assign mrTRG.

Main Results:

  • Seventy patients completed radiotherapy with a median overall treatment time of 34 days.
  • Grade 3+ non-haematological toxicity was 4.2%, and grade 3+ haematological toxicity was 1.5%.
  • RTOG 0822 dose constraints were met in most cases, except for the high-dose bladder constraint. Magnetic resonance tumour regression grade 1-2 was observed in 47.8% of patients.

Conclusions:

  • The IMRT/SIB protocol demonstrates acceptable acute toxicity in rectal cancer patients.
  • Promising magnetic resonance tumour regression grade results suggest potential for improved treatment outcomes.
  • This protocol could be considered an intensity-modulated radiotherapy equivalent to the EXPERT trial dose and fractionation.