Journal of Cancer Research and Clinical Oncology

, Volume 145, Issue 4, pp 1075–1084 | Cite as

Neoadjuvant chemoradiotherapy delivered with helical tomotherapy under daily image guidance for rectal cancer patients: efficacy and safety in a large, multi-institutional series

  • Berardino De BariEmail author
  • Alessandra Franzetti-Pellanda
  • Asma Saidi
  • Maira Biggiogero
  • Dieter Hahnloser
  • Michael Montemurro
  • Jean Bourhis
  • Michele Zeverino
  • Mahmut Ozsahin
Original Article – Clinical Oncology



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.


Helical tomotherapy Rectal cancer Image-guided radiotherapy Toxicity Neoadjuvant chemoradiotherapy 



3-Dimensional radiotherapy




Centre Hospitalier Universitaire Vaudois


Confidence interval


Clinica Luganese


Circumferential resection margin




Computed tomography


Clinical target volume


Disease-free survival


Eastern Cooperative Oncology Group




Gross target volume


Helical tomotherapy


Image-guided radiotherapy


Intensity-modulated radiotherapy


Local control




Metastases-free survival


Magnetic resonance imaging






National comprehensive cancer network


National Cancer Institute-Common Toxicity Criteriafor Advers Events


Organs at risk


Overall survival


Pathological complete response


Positron-emission tomography/CT


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


Author contributions

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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

corrected publication 2019

Authors and Affiliations

  • Berardino De Bari
    • 1
    • 2
    Email author
  • Alessandra Franzetti-Pellanda
    • 3
  • Asma Saidi
    • 1
  • Maira Biggiogero
    • 3
  • Dieter Hahnloser
    • 4
  • Michael Montemurro
    • 5
  • Jean Bourhis
    • 1
  • Michele Zeverino
    • 6
  • Mahmut Ozsahin
    • 1
  1. 1.Radiation Oncology DepartmentCentre Hospitalier Universitaire Vaudois, CHUVLausanneSwitzerland
  2. 2.Radiation Oncology DepartmentCentre Hospitalier Régional Universitaire Jean Minjoz, INSERM U1098 EFS/BFCBesançonFrance
  3. 3.Radiation Oncology DepartmentClinica LuganeseLuganoSwitzerland
  4. 4.Surgery DepartmentCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
  5. 5.Medical Oncology DepartmentCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
  6. 6.Medical Physics DepartmentCentre Hospitalier Universitaire VaudoisLausanneSwitzerland

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