Effect of intensity-modulated radiation therapy with SIB technique on local control and toxicity for neoadjuvant pelvic radiation with concurrent 5-fluorouracil based chemotherapy for rectal cancer compared with three-dimensional conformal radiation therapies.

632 Background: To compare the areas of residual disease after neoadjuvant pelvic radiation with 5-FU based chemotherapy for rectal cancer using Intensity Modulated Radiation Therapy (IMRT) with simultaneous integrated boost (SIB) technique compared to 3D Conformal Radiation Therapy (3DCRT) Methods: Fourty nine (49) consecutive rectal cancer patients treated with pelvic radiation and concurrent 5-FU based chemotherapy were analyzed. We compared twenty-eight (28) patients treated on an institutional IMRT protocol versus twenty-one (21) patients treated with 3DCRT. All patients received 45-50.4 Gy to the pelvis in 3DCRT group. All patients with IMRT received 45 Gy in 25 fractions to the pelvic no des. The primary rectal tumor recieved a simultaneous integrated boost to a dose of 50 Gy in 25 fractions. IMRT planning was done with dose constraints for bladder, rectum, and small bowel and bone marrow. All patients in both groups received 5-FU based chemotherapy during radiation. Evaluation of toxicity was based on RTOG criteria. 2 patients in the 3DCRT group and 2 in IMRT group received either growth factors or blood-products transfusion and needed hospitalization during treatment secondary to acute toxicities. Results: All patients completed their prescribed course of radiation. CR rates were 5/21(23%) in 3DCRT and 4/28(25%) in the IMRT-SIB (p-value 0.74). 9/21(42%) in 3D and 19/29(65%) in the IMRT group underwent Low anterior resection according to the location of the tumor. There was no grade 4 toxicity in the IMRT-SIB group. Overall grade 2 toxicity in 3D Vs IMRT-SIB group was - GI -52% Vs 19%, GU- 8% Vs 8%, skin 42 Vs 4%, hematologic 33 Vs 47%. Overall Grade 1 toxicity in 3DCRT Vs IMRT group was- GI- 33% Vs 52%, GU 23% vs 28%, Skin 52% Vs 38%, hematologic 4% Vs 33%. Conclusions: Neoadjuvant pelvic radiation with 5 FU for rectal cancer has similar local control rates. There is less GI, skin and hematologic toxicity when delivered via IMRT-SIB versus 3DCRT. IMRT is safe and may allow dose escalation with potential probability of increased tumor response.

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Comparison of Simultaneous Integrated Boost and Late-course Boost Intensity-modulated Radiation Therapy in the Treatment of Esophageal Carcinoma

10.21203/rs.3.rs-835617/v1 ◽

2021 ◽

Author(s):

Yu Xiao ◽

Guobo Du ◽

Jianping Hu ◽

Tingting Wu ◽

Xue Meng ◽

...

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Esophageal Carcinoma ◽

Local Control ◽

Intensity Modulated Radiation Therapy ◽

Simultaneous Integrated Boost ◽

Entire Group ◽

Target Area ◽

Intensity Modulated ◽

Integrated Boost

Abstract This paper aimed to analyze and compare the outcomes of esophageal carcinoma treated with simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) and late-course boost intensity-modulated radiation therapy (LCB-IMRT). The retrospective study was designed to analyze the clinical data of 274 esophageal cancer patients who received radical radiotherapy in the Oncology Department of our hospital, from January 2014 to December 2017. Propensity score matching analysis was used to balance the variable differences in the two groups. Survival, toxicities, and target dose were observed and compared between the two groups. Statistical analysis was performed using SPSS 24.0 software. P<0.05 judged to be statistically significant. 200 patients were finally included after propensity scores matching , The 1-, 3-, and 5-year overall survival and local control rates of the entire group were 80.5% vs. 67.6%, 38.2% vs. 31.3%，and 22.2% vs. 20.4%, respectively. The 1-, 3-, and 5-year overall survival rates of the SIB-IMRT and LCB-IMRT group were 85.0% vs. 76.0%, 41.8% vs. 34.5%, and 25.5% vs. 21.3%, respectively (P＞0.05). The 1-, 3-, and 5- year local control rates of the SIB-IMRT and LCB-IMRT group were 77.3% vs. 58.0%, 31.4% vs. 30.1%, and 20.0% vs. 20.7%, respectively (P＞0.05). The recent total effective rates of the SIB-IMRT and LCB-IMRT group were 96.0% vs. 92.0% (P＞0.05). There were statistically significant differences in the incidence of ≥2 grade acute radiation esophagitis and pneumonia between the two groups (P＜0.05). The does of lung V5, lung V10, lung Dmean, and spinal cord Dmax in the SIB-IMRT group were significantly lower than those in LCB-IMRT group (P＜0.05). Patients age, tumor location, tumor length, gross tumor target volume, N stage were independent prognostic factors of overall survival and local control. Compared with the LCB-IMRT group, the survival prognosis of the SIB-IMRT group has benefit trend, patients in the SIB-IMRT group received less radiation dose to the normal organs around the target area, and the toxicities effects of radiotherapy were lighter, which is more conducive to the protection of normal tissues around the target area.

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Preoperative intensity-modulated chemoradiation therapy with simultaneous integrated boost in rectal cancer: 2-year follow-up results of phase II study

Radiology and Oncology ◽

10.1515/raon-2018-0007 ◽

2018 ◽

Vol 52 (1) ◽

pp. 23-29 ◽

Cited By ~ 5

Author(s):

Jasna But-Hadzic ◽

Vaneja Velenik

Keyword(s):

Rectal Cancer ◽

Radiation Therapy ◽

Acute Toxicity ◽

Intensity Modulated Radiation Therapy ◽

Simultaneous Integrated Boost ◽

Significant Prognostic Factor ◽

Preoperative Treatment ◽

Intensity Modulated ◽

Integrated Boost

Abstract Background The aim of the study was to investigate the feasibility and safety of experimental fractionation using intensity modulated radiation therapy with a simultaneous integrated boost (IMRT-SIB) to shorten the overall treatment time without dose escalation in preoperative radiochemotherapy of locally advanced rectal cancer. Patients and methods Between January 2014 and November 2015, a total of 51 patients with operable stage II-III rectal adenocarcinoma were treated. The preoperative treatment with intensity modulated radiation therapy (IMRT) and a pelvic dose of 41.8 Gy and simultaneously delivered 46.2 Gy to T2/3 and 48.4 Gy to T4 tumour in 22 fractions, with standard concomitant capecitabine, was completed in 50 patients out of whom 47 were operated. The median follow-up was 35 months. Results The rate of acute toxicity G ≥ 3 was 2.4%. The total downstaging rate was 89% and radical resection was achieved in 98% of patients. Pathologic complete response (pCR) was observed in 25.5% of patients, with 2-year local control (LC), disease free survival (DFS), and overall survival (OS) of 100% for this patient group. An intention-to-treat analysis revealed pN to be a significant prognostic factor for DFS and OS (P = 0.005 and 0.030, respectively). LC for the entire group was 100%, and 2-year DFS and OS were 90% (95 % CI 98.4–81.6) and 92.2% (95% CI 99.6–84.7), respectively. Conclusions The experimental regime in this study resulted in a high rate of pCR with a low acute toxicity profile. Excellent early results translated into encouraging 2-year LC, DFS, and OS.

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