Strahlentherapie und Onkologie

, Volume 190, Issue 6, pp 515–520 | Cite as

Complete pathological responses in locally advanced rectal cancer after preoperative IMRT and integrated-boost chemoradiation

  • Ovidio Hernando-Requejo
  • Mercedes López
  • Antonio Cubillo
  • Almudena Rodriguez
  • Raquel Ciervide
  • Jeannette Valero
  • Emilio Sánchez
  • Mariola Garcia-Aranda
  • Jesus Rodriguez
  • Guillermo Potdevin
  • Carmen Rubio
Original article

Abstract

Background and purpose

To analyze the efficacy and safety of a new preoperative intensity-modulated radiotherapy (IMRT) and integrated-boost chemoradiation scheme.

Patients and methods

In all, 74 patients were treated with IMRT and concurrent standard dose capecitabine. The dose of the planning target volume (PTV) encompassing the tumor, mesorectum, and pelvic lymph nodes was 46 Gy in 23 fractions; the boost PTV, at a dose of 57.5 Gy in 23 fractions, included the macroscopic primary tumor and pathological lymph nodes. The patients underwent surgery 6–8 weeks after chemoradiation.

Results

The complete treatment data of 72 patients were analyzed. Tumor downstaging was achieved in 55 patients (76.38 %) and node downstaging in 34 (47.2 %). In 22 patients (30.6 %), there was complete pathological response (ypCR). The circumferential resection margin was free of tumor in 70 patients (97.2 %). The 3-year estimated overall survival and disease-free survival rates were 95.4 and 85.9 % respectively, and no local relapse was found; however, ten patients (13.8 %) developed distant metastases. High pathologic tumor (pT) downstaging was shown as a favorable prognostic factor for disease-free survival. No grade 4 acute radiotherapy-related toxicity was found.

Conclusions

The IMRT and integrated-boost chemoradiation scheme offered higher rates of ypCR and pT downstaging, without a significant increase in toxicity. The circumferential margins were free of tumors in the majority of patients. Primary tumor regression was associated with better disease-free survival.

Keywords

Rectal carcinoma Chemoradiation Intensity-modulated radiotherapy Downstaging Pathological complete response 

Komplette pathologische Remissionen bei lokal fortgeschrittenem Rektalkarzinom nach präoperativer IMRT- und integrierter Boost-Radiochemotherapie

Zusammenfassung

Hintergrund und Ziel

Analyse von Wirksamkeit und Sicherheit eines neuen präoperativen intensitätsmodulierten Bestrahlungsschemas (IMRT) mit integriertem Boost.

Patienten und Methodik

Insgesamt 74 Patienten wurden simultan mit IMRT und Capecitabin (Standarddosis) behandelt. Die Dosis des Planungszielvolumens (PTV) umfasste den Tumor, das Mesorektum sowie die Beckenlymphknoten und betrug 46 Gy in 23 Fraktionen. Das Boost-PTV betrug 57,5 Gy in 23 Fraktionen und umfasste den makroskopischen Primärtumor und die erkrankten Lymphknoten. Die Patienten wurden 6–8 Wochen nach der Radiochemotherapie operiert.

Ergebnisse

Es wurden die vollständigen Behandlungsdaten von 72 Patienten analysiert. Ein Tumor-Downstaging zeigten 55 Patienten (76,38 %) und ein Lymphknoten-Downstaging 34 Patienten (47,2 %). Ein vollständiger Rückgang des Tumors (pCR) war bei 22 Patienten zu beobachten (30,6 %). Der tumorumgebende Resektionsrand war bei 70 Patienten tumorfrei (97,2 %). Das allgemeine 3-Jahres-Überleben und das krankheitsfreie Überleben lagen jeweils bei 95,4 bzw. 85,9 %. Lokalrezidive traten nicht ein, jedoch haben sich bei 10 Patienten Fernmetastasen entwickelt (13,8 %). Ein Primärtumor-Downstaging wirkte sich positiv auf die Prognose bezüglich eines krankheitsfreien Überlebens aus. Es wurde keine Grad-4-Toxizität beobachtet.

Schlussfolgerungen

Das untersuchte IMRT-Bestrahlungsschema mit integriertem Boost zeigt eine höhere Wahrscheinlichkeit einer vollständigen Rückbildung und eines pathologischen Downstagings ohne wesentliche Toxizitätserhöhung. Der umgebende Resektionsrand war bei den meisten Patienten tumorfrei. Die beobachtete Primärtumorregression wurde mit besseren krankheitsfreien Überlebenschancen in Zusammenhang gebracht.

Schlüsselwörter

Rektumkarzinom Strahlenchemotherapie Intensitätsmodulierte Strahlentherapie Downstaging Pathologisch vollständige Remission 

Notes

Compliance with ethical guidelines

Conflict of interest

O. Hernando-Requejo, M. López, A. Cubillo, A. Rodriguez, R. Ciervide, J. Valero, E. Sánchez, M. Garcia-Aranda, J. Rodriguez, G. Potdevin, and C. Rubio state that there are no conflicts of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Ovidio Hernando-Requejo
    • 1
    • 3
    • 4
  • Mercedes López
    • 1
  • Antonio Cubillo
    • 2
    • 3
  • Almudena Rodriguez
    • 1
  • Raquel Ciervide
    • 1
  • Jeannette Valero
    • 1
  • Emilio Sánchez
    • 1
  • Mariola Garcia-Aranda
    • 1
  • Jesus Rodriguez
    • 2
    • 3
  • Guillermo Potdevin
    • 1
  • Carmen Rubio
    • 1
    • 3
  1. 1.Department of Radiation OncologyHospital Universitario SanchinarroMadridSpain
  2. 2.Department of Medical OncologyHospital Universitario SanchinarroMadridSpain
  3. 3.CEU San Pablo UniversityHospital Universitario SanchinarroMadridSpain
  4. 4.Centro Integral Oncológico Clara CampalHM Universitario SanchinarroMadridSpain

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