A comparative analysis between radiation dose intensification and conventional fractionation in neoadjuvant locally adva
- PDF / 636,852 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 94 Downloads / 164 Views
RADIOTHERAPY
A comparative analysis between radiation dose intensification and conventional fractionation in neoadjuvant locally advanced rectal cancer: a monocentric prospective observational study Elisa Bertocchi1 · Giuliano Barugola1 · Luca Nicosia2 · Rosario Mazzola2 · Francesco Ricchetti2 · Paolo Dell’Abate3 · Filippo Alongi2,4 · Giacomo Ruffo1 Received: 23 January 2020 / Accepted: 30 March 2020 © Italian Society of Medical Radiology 2020
Abstract Purpose The potential role of neoadjuvant radiation dose intensification in locally advanced rectal cancer (LARC) is still largely debated. In the present study, a comparative analysis between radiation dose intensification and conventional fractionation was performed. Materials and methods In the current prospective observational study (protocol ID RT-03/2011), 56 patients diagnosed with LARC were enrolled between January 2013 and December 2016. More specifically, 25 patients underwent preoperative conventional radiation dose [i.e., 50.4 Gy in 28 fractions here defined as standard dose radiotherapy (SDR)—group 1], whereas 31 patients were candidate for radiation dose intensification (RDI) (i.e., 60 Gy in 30 fractions—group 2). The primary endpoint was the complete pathological response (pCR) rate. Secondary endpoints were postoperative complications and ChT-RT-related toxicity. Results No statistical significance was observed in pCR rate (20.8% and 22.6% in SDR and RDI group, respectively, p = 0.342). Of contrast, the RDI group showed a significantly higher primary tumor downstaging in case of T3 tumor compared to SDR group (p = 0.049). Sphincter-preserving surgery was 84% and 93.5% in SDR and RDI groups, respectively (p = 0.25). All patients had R0 margins. No surgical-related death was recorded. No statistically significant difference was observed regarding surgical complications and incomplete mesorectal excision. Acute genitourinary toxicity was significantly higher in RDI group (p = 0.015). Conclusions The intensification of the neoadjuvant radiotherapy for LARC seems to produce a major pathological response in T3 tumors. The radiation dose intensification appears probably associated with a higher rate of genitourinary toxicity. Keywords Rectal cancer · Dose intensification · Radiotherapy · Surgery · Postoperative complications · Toxicity
Introduction
* Luca Nicosia [email protected] 1
Department of Surgery, IRCCS - Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, 37024 Negrar, Verona, Italy
2
Department of Advanced Radiation Oncology, IRCCS - Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, 37024 Negrar, Verona, Italy
3
Department of Surgical Science, University Hospital of Parma, Via Gramsci, 14 ‑ 43126 Parma, Italy
4
University of Brescia, Brescia, Italy
The treatment for locally advanced rectal cancer (LARC) has improved in the last decades. Nowadays, a multidisciplinary approach is strongly advocated since that improvement in pretreatment diagnostic imaging, the integration of (neo) adjuvant radiothe
Data Loading...
