scholarly journals Radiation Therapy Dose Escalation to Clinically Involved Pelvic Sidewall Lymph Nodes in Locally Advanced Rectal Cancer

2019 ◽  
Vol 4 (3) ◽  
pp. 478-486 ◽  
Author(s):  
Pehr E. Hartvigson ◽  
Smith Apisarnthanarax ◽  
Stephanie Schaub ◽  
Stacey Cohen ◽  
Greta Bernier ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Lymph Nodes ◽  
Dose Escalation ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer

Dose escalation using dose-painted IMRT in locally advanced rectal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 582-582
Author(s):  
Maged Ghaly ◽  
Lili Vijeh ◽  
Mihaela Marrero ◽  
Vincent Vinciguerra ◽  
Luz Paulina Angel ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Acute Toxicity ◽  
Clinical Response ◽  
Dose Escalation ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Clinical Staging ◽  
Pet Ct

582 Background: After preoperative chemo-radiation, clinical response and tumor pathologic downstaging showed a close correlation with improved outcomes. We report our initial experience in dose escalation using dose-painted intensity-modulated radiation therapy (DP-IMRT) in patients with locally advanced rectal cancer. Methods: Fifteen patients with locally advanced rectal cancer (T3-4,N0-1) were prospectively identified. Tumors were staged using the cTNM classification by PET/CT, EUS & MRI. All received preoperative 5-FU and DP-IMRT. Doses were prescribed as follows:56 Gy/2.0 Gy fractions (fxn) to the planning target volume (PTV) and 47.6Gy/1.7Gyfxn to elective nodal PTV. Surgery was performed 6-8 weeks after chemo-radiation. The surgical procedure was tailored to tumor downstaging. The choice of sphincter-preserving surgery was based on the distance between the lower tumor pole and the anorectal ring “ after” chemoradiation. All were reevaluated for tumor response, preoperatively by imaging studies (ycTNM) and by pathological staging (ypTN) following surgery. Acute and late toxicities were monitored by the treating physician. Results: All patients completed therapy. Tumors were in the lower 1/3 in 3 patients, middle 1/3 in 7, and upper 1/3 in 5. With preoperative endorectal US, PET/CT and MRI, the clinical staging of the tumors was: 13 (T3N0) and 2 (T4N0). Acute toxicity was limited to a moderate proctitis (RTOG acute toxicity scoring system, G1 ) in all patients, with two patients with tumors extending into the anal canal having G 3 dermatitis. Complete clinical response was obtained in 10 of 15 patients.All 15 underwent surgery; 6 had pathological pT0N0, 4 had residual micro foci of carcinoma (pT1N0), and 5 had residual disease limited to the muscularis propria (pT2N0). No difference in perioperative complications was seen. Conclusions: Preoperative dose-escalation using dose-painted radiation therapy (DP-IMRT) seems to be safe. Moderate local acute toxicity was seen with very low-lying tumors. This modality provides a high rate of tumor downsizing especially for patients with lesions in the lower 2/3 of the rectum with a possible potential for an increased ability to perform sphincter-preserving surgery.

Immediate Results of a Prolonged Course of Neoadjuvant Chemoradiotherapy for Patients with Locally Advanced Rectal Cancer: a Comparison of Classical and Hypofractional Regimes

2020 ◽  
Vol 65 (2) ◽  
pp. 34-43
Author(s):  
A. Abdujapparov ◽  
Sergey Tkachev ◽  
V. Aliev ◽  
D. Romanov ◽  
A. Nazarenko ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Lymph Nodes ◽  
Primary Tumor ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Main Group ◽  
Control Group

Purpose: To compare the effectiveness of the hypofractional and classical modes of radiation therapy in a neoadjuvant prolonged course of chemoradiotherapy for patients with locally advanced rectal cancer (LARC). Material and methods: This work is based on a retrospective analysis of the database of patients with LARC, who from 2013 to 2017 underwent a prolonged course of neoadjuvant chemoradiotherapy with subsequent surgical intervention. Patients were divided into two groups: the first (main) group, 71 patients with LARC, who, as part of the neoadjuvant treatment, underwent a course of chemoradiotherapy (CRT) in the hypofractionation mode (4 Gy, 3 fractions per week, 32 Gy to regional lymph nodes pelvis and up to 40 Gy to the primary tumor) in combination with chemotherapy with capecitabine 1650 mg/m2 in two doses daily on weekdays. The second group (control group) included 79 patients with LARC, who underwent CRT in the classical fractionation regimen (2 Gy, 5 fractions per week, 44 Gy to regional pelvic lymph nodes and up to 50–58 Gy to the primary tumor) in combination with capecitabine chemotherapy 1650 mg/m2 in two doses on the days of radiation therapy. Results: The average duration of a prolonged course of CRT in the main group was 22.56 (95 % CI from 21.94 to 23.18) calendar days, in the control group — 38.84 (95 % CI from 38.12 to 39.54), p = 0.0001. Pathological response of the III degree in the main group was recorded in 23 % of cases, and of the IV degree in 18 %, in the control group these indicators were 19 % and 15 %, respectively, p = 0.4. A decrease in the stage of the tumor process was recorded in 50 (70.4 %) cases in the main group and in 47 (59.5 %) cases in the control group, p = 0.16. No statistically significant differences were observed in the incidence and severity of cases of hematological and local toxicity. Conclusion: The results of our study confirm that the use of a prolonged course of neoadjuvant chemoradiotherapy in hypofractionation mode does not worsen oncological results, does not increase the frequency and severity of early and late radiation injuries, but at the same time reduces the duration of the course of treatment by two weeks. The hypofractionation regimen can be considered as an alternative and not inferior to the classical regimen in the neoadjuvant course of CRT of patients with LARC.

scholarly journals The prognostic impact of neoadjuvant chemoradiotherapy on lymph node sampling in patients with locally advanced rectal cancer

2020 ◽  
Vol 72 (3) ◽  
pp. 793-800 ◽  
Author(s):  
Giovanni Li Destri ◽  
Andrea Maugeri ◽  
Alice Ramistella ◽  
Gaetano La Greca ◽  
Pietro Conti ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Prognostic Impact ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
Lymph Node Retrieval

Abstract According to the American Joint Committee on Cancer, at least 12 lymph nodes are required to accurately stage locally advanced rectal cancer (LARC). Neoadjuvant chemoradiation therapy (NACRT) reduces the number of lymph nodes retrieved during surgery. In this study, we evaluated the effect of NACRT on lymph node retrieval and prognosis in patients with LARC. We performed an observational study of 142 patients with LARC. Although our analysis was retrospective, data were collected prospectively. Half the patients were treated with NACRT and total mesorectal excision (TME) and the other half underwent TME only. The number of lymph nodes retrieved and the number of metastatic lymph nodes were significantly reduced in the NACRT group (P > 0.001). In the univariate and multivariate analyses, only NACRT and patient age were significantly associated with reduced lymph node retrieval. The number of metastatic lymph nodes and the lymph node ratio (LNR) both had a significant effect on prognosis when the patient population was examined as a whole (P = 0.003 and P = 0.001, respectively). However, the LNR was the only significant, independent prognostic factor in both treatment groups (P = 0.007 for the NACRT group; P = 0.04 for the no-NACRT group). NACRT improves patient prognosis only when the number of metastatic lymph nodes is reduced. The number of metastatic lymph nodes and the LNR are important prognostic factors. Lymph node retrieval remains an indispensable tool for staging and prognostic assessment of patients with rectal carcinoma treated with NACRT.

Sign in / Sign up

Export Citation Format

Share Document