Dose Escalation with Simultaneous Integrated Boost (SIB) Using Volumetric Modulated Arc Therapy (VMAT) in Rectal Cancer
Assess feasibility—rate of PCR, short-term toxicity after neoadjuvant concurrent chemoradiation (NACRT) delivered via simultaneous integrated boost (SIB) using volumetric modulated arc therapy (VMAT) technique for locally advanced rectal cancer.
Retrospective evaluation of patients with locally advanced rectal cancer treated with VMAT-SIB technique preoperatively at an academic tertiary care center in Riyadh, Saudi Arabia between February 2013 and March 2017.
One hundred patients with depth of invasion staged as T3/T4 or T2 in 93 and seven patients, respectively. Lymph node metastasis was staged as N1/N2 or N0 in 87 and 13 patients, respectively. Circumferential radial margin (CRM) was involved radiologically prior to treatment in 50 patients. A dose of 55 or 50 Gy was given to 71 and 29 patients, respectively. All treatments were completed without interruption. Grade 3/4 toxicity was not observed. Low anterior resection and abdominoperineal resection were performed with negative proximal, distal, and radial margins in 72 and 28 patients, respectively. There were no immediate significant postoperative complications. Histologically, no residual tumor (grade 0) was noted in 20 patients (pCR). Regression grade 1, 2, and 3 were noted in 31, 34, and 15 patients. Average number of lymph nodes retrieved in the surgical specimen was 12 (range 6–22). Lymph nodes were negative for cancer in 80 patients.
Dose escalation with SIB-VMAT as NACRT for rectal cancer is feasible. Moreover, it can increase the rate of pathological complete response with a favorable toxicity profile. Clinical benefit of this approach needs to be validated in a larger cohort of patients with longer follow-up.
KeywordsRectal Cancer Volumetric modulated arc therapy (VMAT) Radiation Therapy Surgery Chemotherapy Complete Pathology Response Dose Toxicity Patients Simultaneous integrated boost (SIB)
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- 2.Alsanea N, Abduljabbar AS, Alhomoud S, Ashari LH, Hibbert D, Bazarbashi S. Colorectal cancer in Saudi Arabia: incidence, survival, demographics and implications for national policies. Ann Saudi Med. 2015;35(3):196–202. https://doi.org/10.5144/0256-4947.2015.196. CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Menkarios C, Azria D, Laliberté B, Moscardo C, Gourgou S, Lemanski C, et al. Optimal organ-sparing intensity-modulated radiation therapy (IMRT) regimen for the treatment of locally advanced anal carcinoma: a comparison of conventional and IMRT plans. Radiat Oncol. 2007;2:41.CrossRefPubMedPubMedCentralGoogle Scholar
- 28.RTOG protocol 0022. Phase I/II study of conformal and intensity modulated irradiation for oropharyngeal cancer. http://www.rtog.org.members/protocols/h0022/h0022.pdf.
- 35.Bourhis J, Sire C, Lapeyre M, et al. Accelerated radiotherapy and/or concomitant chemotherapy in locally advanced head and neck SCC: results of a GORTEC randomized trial. Radiother Oncol. 2008;88(2):S121.Google Scholar
- 36.Aschele C, Pinto C, Cordio S, et al. Preoperative fluorouracil (FU)-based chemoradiation with and without weekly oxaliplatin in locally advanced rectal cancer: Pathologic response analysis of the Studio Terapia Adiuvante Retto (STAR)-01 randomized phase III trial. J Clin Oncol. 2009;27:170s. (suppl; abstr CRA4008)CrossRefGoogle Scholar