Dose Escalation with Simultaneous Integrated Boost (SIB) Using Volumetric Modulated Arc Therapy (VMAT) in Rectal Cancer

  • Abdullah AlsuhaibaniEmail author
  • Ahmed Elashwah
  • Rana Mahmood
  • Alaa Abduljabbar
  • Samar Alhomoud
  • Luai Ashari
  • Shouki Bazarbashi
  • Ali Aljubran
  • Ahmed Alzahrani
  • Muhamed Mohiuddin
  • Hadeel Almanea
  • Hussah Alhussaini
  • Nasser AlSanea
Original Research



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.


Rectal 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.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Abdullah Alsuhaibani
    • 1
    Email author
  • Ahmed Elashwah
    • 2
    • 3
  • Rana Mahmood
    • 2
  • Alaa Abduljabbar
    • 4
  • Samar Alhomoud
    • 4
  • Luai Ashari
    • 4
  • Shouki Bazarbashi
    • 5
  • Ali Aljubran
    • 5
  • Ahmed Alzahrani
    • 5
  • Muhamed Mohiuddin
    • 2
  • Hadeel Almanea
    • 6
  • Hussah Alhussaini
    • 6
  • Nasser AlSanea
    • 4
  1. 1.Oncology Center ,University Medical CityKing Saud UniversityRiyadhSaudi Arabia
  2. 2.Section of Radiation OncologyKing Faisal Specialist Hospital & Research CentreRiyadhSaudi Arabia
  3. 3.Kasr Al-Eini Center of Clinical Oncology (NEMROCK)Cairo UniversityCairoEgypt
  4. 4.Section of Colon and Rectal SurgeryKing Faisal Specialist Hospital & Research CentreRiyadhSaudi Arabia
  5. 5.Section of Medical OncologyKing Faisal Specialist Hospital & Research CentreRiyadhSaudi Arabia
  6. 6.Pathology and Laboratory MedicineKing Faisal Specialist Hospital & Research CentreRiyadhSaudi Arabia

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