Neoadjuvant chemoradiotherapy delivered with helical tomotherapy under daily image guidance for rectal cancer patients: efficacy and safety in a large, multi-institutional series
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Helical 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.
Data 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.
Median 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%).
Neoadjuvant chemoradiotherapy delivered with HT under daily image guidance is well tolerated and shows a high 4-year local control rates.
KeywordsHelical tomotherapy Rectal cancer Image-guided radiotherapy Toxicity Neoadjuvant chemoradiotherapy
Centre Hospitalier Universitaire Vaudois
Circumferential resection margin
Clinical target volume
Eastern Cooperative Oncology Group
Gross target volume
Magnetic resonance imaging
National comprehensive cancer network
National Cancer Institute-Common Toxicity Criteriafor Advers Events
Organs at risk
Pathological complete response
Planning target volume
Radiation Therapy Oncology Group
Simultaneous integrated boost
Statistical package for the social sciences
Tumor regression grade
Union Internationale Contre le Cancer
World Health Organization
BDB, AFP, AS, and MB contributed to data collection. BDB and MO contributed to data analyses. BDB, AFP, DH, MM, JB, and MO contributed to the article writing. All the authors contributed to the final content of the article in terms of conception and design, analysis, and interpretation of data; they contributed to the drafting of the article by revising it critically. All the authors contributed to the final approval of the version to be published.
The authors declare that they have no funding for this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
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corrected publication 2019