Abstract
PurposeHelical tomotherapy (HT) has been recently introduced in the neoadjuvant treatment of locally advanced rectal cancer. Aim of this study is to report the toxicity and local control rates of a large series of locally advanced rectal cancer patients treated with neoadjuvant chemotherapy and HT under daily image guidance followed by surgery.MethodsData from 117 locally advanced rectal cancer patients treated at two Swiss Radiotherapy departments were collected and analyzed. Radiotherapy consisted of 45 Gy (1.8 Gy/fraction, 5 fractions/week delivered in 5 weeks) to the regional pelvic lymph nodes. Seventy patients also received a simultaneous integrated boost (SIB) up to 50 Gy to the tumor and involved nodes (2 Gy/fraction, 5 fractions/week delivered in 5 weeks). Chemotherapy consisted of capecitabine 825 mg/m2, twice daily, during the irradiation days. After a median interval of 59 days [95% confidence interval (CI) 53–65 days), all patients underwent surgery.ResultsMedian follow-up was 45 months (range 4–90 months). The overall rate of acute grade 2–4 toxicity was 18.8% (n = 22). Four patients (3.4%) presented a grade 3 dermatitis (n = 1) or diarrhea (n = 3), and 1 (0.8%) demonstrated grade 4 rectal toxicity. No patients presented with grade ≥ 3 hematologic toxicity. Six patients (5.1%) had late grade 3 gastrointestinal toxicity. The 4-year local control rate was 88.4% (95% CI 87.5–88.5%).ConclusionsNeoadjuvant chemoradiotherapy delivered with HT under daily image guidance is well tolerated and shows a high 4-year local control rates.
Highlights
Neoadjuvant radiotherapy (RT), with or without chemotherapy, is the standard treatment for patients with locally advanced rectal cancer, as it has been shown to improve the local control of the tumor (Benson et al 2018)
In some cases, when the description of the toxicity was not clear, the worst case scenario was considered
Toxicity recorded within 3 months after the end of the treatment was considered as acute toxicity, whereas all others observed afterwards were considered as late toxicities
Summary
Neoadjuvant radiotherapy (RT), with or without chemotherapy, is the standard treatment for patients with locally advanced rectal cancer, as it has been shown to improve the local control of the tumor (Benson et al 2018). Several studies have already shown that the risk of both acute and late adverse events is proportional to the maximum prescribed dosage and the total irradiated bowel volume (Baglan et al 2002; Goupy et al 2017; Reis et al 2015). When adopted for the irradiation of pelvic targets, the intensity-modulated radiotherapy (IMRT) has the ability to reduce the volume of the bowel being irradiated, as demonstrated in several dosimetric studies (Guerrero Urbano et al 2006; Mok et al 2011), and thereby decreasing the risk of radiation-induced adverse events (Viani et al 2016; Yu et al 2015). Four retrospective studies showed that the use of IMRT in the treatment of locally advanced rectal cancer patients could reduce the rates of acute adverse events (Teoh and Muirhead 2016; Jabbour et al 2012; Parekh et al 2013; Samuelian et al 2012)
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