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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
  • 141 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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%).

Conclusions

Neoadjuvant chemoradiotherapy delivered with HT under daily image guidance is well tolerated and shows a high 4-year local control rates.

Keywords

Helical tomotherapy Rectal cancer Image-guided radiotherapy Toxicity Neoadjuvant chemoradiotherapy 

Abbreviations

3D-RT

3-Dimensional radiotherapy

5-FU

5-Fluorouracile

CHUV

Centre Hospitalier Universitaire Vaudois

CI

Confidence interval

CL

Clinica Luganese

CRM

Circumferential resection margin

CRT

Chemoradiotherapy

CT

Computed tomography

CTV

Clinical target volume

DFS

Disease-free survival

ECOG

Eastern Cooperative Oncology Group

G

Grade

GTV

Gross target volume

HT

Helical tomotherapy

IGRT

Image-guided radiotherapy

IMRT

Intensity-modulated radiotherapy

LC

Local control

M

Metastases

MFS

Metastases-free survival

MRI

Magnetic resonance imaging

MV

MegaVolt

N

Nodes

NCCN

National comprehensive cancer network

NCI-CTCAE

National Cancer Institute-Common Toxicity Criteriafor Advers Events

OARs

Organs at risk

OS

Overall survival

pCR

Pathological complete response

PET/CT

Positron-emission tomography/CT

PTV

Planning target volume

RT

Radiotherapy

RTOG

Radiation Therapy Oncology Group

SIB

Simultaneous integrated boost

SPSS

Statistical package for the social sciences

T

Tumor

TRG

Tumor regression grade

UICC

Union Internationale Contre le Cancer

WHO

World Health Organization

Notes

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.

Funding

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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