Radiat Oncol J.  2017 Sep;35(3):208-216. 10.3857/roj.2017.00353.

Simultaneous integrated boost intensity-modulated radiotherapy versus 3-dimensional conformal radiotherapy in preoperative concurrent chemoradiotherapy for locally advanced rectal cancer

Affiliations
  • 1Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea. mkkang@knu.ac.kr
  • 2Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Korea.
  • 3Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
  • 4Department of Oncology/Hematology, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea.

Abstract

PURPOSE
To evaluate the feasibility of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for preoperative concurrent chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC), by comparing with 3-dimensional conformal radiotherapy (3D-CRT).
MATERIALS AND METHODS
Patients who were treated with PCRT for LARC from 2015 January to 2016 December were retrospectively enrolled. Total doses of 45 Gy to 50.4 Gy with 3D-CRT or SIB-IMRT were administered concomitantly with 5-fluorouracil plus leucovorin or capecitabine. Surgery was performed 8 weeks after PCRT. Between PCRT and surgery, one cycle of additional chemotherapy was administered. Pathologic tumor responses were compared between SIB-IMRT and 3D-CRT groups. Acute gastrointestinal, genitourinary, hematologic, and skin toxicities were compared between the two groups based on the RTOG toxicity criteria.
RESULTS
SIB-IMRT was used in 53 patients, and 3D-CRT in 41 patients. After PCRT, no significant differences were noted in tumor responses, pathologic complete response (9% vs. 7%; p = 1.000), pathologic tumor regression Grade 3 or higher (85% vs. 71%; p = 0.096), and R0 resection (87% vs. 85%; p = 0.843). Grade 2 genitourinary toxicities were significantly lesser in the SIB-IMRT group (8% vs. 24%; p = 0.023), but gastrointestinal toxicities were not different across the two groups.
CONCLUSION
SIB-IMRT showed lower GU toxicity and similar tumor responses when compared with 3D-CRT in PCRT for LARC.

Keyword

Rectal neoplasms; Intensity-modulated radiotherapy; Conformal radiotherapy; Chemoradiotherapy; Neoadjuvant therapy

MeSH Terms

Capecitabine
Chemoradiotherapy*
Drug Therapy
Fluorouracil
Humans
Leucovorin
Neoadjuvant Therapy
Radiotherapy, Conformal*
Radiotherapy, Intensity-Modulated*
Rectal Neoplasms*
Retrospective Studies
Skin
Capecitabine
Fluorouracil
Leucovorin
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