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Preoperative Chemoradiotherapy with Concomitant Small Field Boost Irradiation for Locally Advanced Rectal Cancer: A Multi-Institutional Phase II Study (KROG 04-01)

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Diseases of the Colon & Rectum

Purpose

This study was designed to determine the effect of concomitant small field boost irradiation given during preoperative chemoradiotherapy for patients with locally advanced rectal cancer.

Methods

The study prospectively enrolled 38 patients scheduled for preoperative chemoradiotherapy. Pelvic radiotherapy of 43.2 Gy/24 fractions was delivered and boost radiotherapy of 7.2 Gy/12 fractions was concomitantly administered during the latter half of the pelvic radiotherapy treatment period. Two cycles of a bolus 5-fluorouracil and leucovorin injection in the first and fifth weeks of radiotherapy were administered. The median time to surgery after completion of chemoradiotherapy was six weeks. Tumor responses to chemoradiotherapy were assessed by using magnetic resonance volumetry and postchemoradiotherapy pathology tests to determine tumor downstaging and tumor regression rate.

Results

Thirty-six of 38 patients (94.7 percent) underwent the scheduled surgery. The mean tumor volume reduction rate was 70.3 percent, and the clinical response rate was 66.7 percent. The downstaging rates were 41.7 percent for T classification, 85.2 percent for N classification, and 72.2 percent for stage. Tumor regression grades after preoperative chemoradiotherapy were Grade 1 in 5 patients (13.9 percent), Grade 2 in 24 patients (66.7 percent), Grade 3 in 3 patients (8.3 percent), and Grade 4 in 4 patients (11.1 percent). Ten patients (26.3 percent) experienced ≥ Grade 3 acute toxicity.

Conclusions

Our data suggest that concomitant boost irradiation does not improve clinical outcomes compared with other published preoperative chemoradiotherapy regimens. In addition, the clinicians choosing to use concomitant small field boost irradiation should be cautious to minimize the risk of unplanned sphincter ablation.

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References

  1. R Sauer H Becker W Hohenberger et al. (2004) ArticleTitlePreoperative versus postoperative chemoradiotherapy for rectal cancer N Engl J Med 351 1731–1740 Occurrence Handle15496622 Occurrence Handle1:CAS:528:DC%2BD2cXovFSksbo%3D Occurrence Handle10.1056/NEJMoa040694

    Article  PubMed  CAS  Google Scholar 

  2. JP Gerard O Chapet C Nemoz et al. (2004) ArticleTitleImproved sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: The Lyon R96-02 Randomized Trial J Clin Oncol 22 2404–2909 Occurrence Handle15197202 Occurrence Handle10.1200/JCO.2004.08.170

    Article  PubMed  Google Scholar 

  3. A Habr-Gama RO Perez W Nadalin et al. (2005) ArticleTitleLong-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival J Gastrointest Surg 9 90–99 Occurrence Handle15623449 Occurrence Handle10.1016/j.gassur.2004.10.010

    Article  PubMed  Google Scholar 

  4. FM Vecchio V Valentini BD Minsky et al. (2005) ArticleTitleThe relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer Int J Radiat Oncol Biol Phys 62 752–760 Occurrence Handle15936556 Occurrence Handle10.1016/j.ijrobp.2004.11.017

    Article  PubMed  Google Scholar 

  5. C Rodel P Martus T Papadoupolos et al. (2005) ArticleTitlePrognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer J Clin Oncol 23 8688–8696 Occurrence Handle16246976 Occurrence Handle10.1200/JCO.2005.02.1329

    Article  PubMed  Google Scholar 

  6. AK Chan A Wong D Jenken J Heine D Buie D Johnson (2005) ArticleTitlePosttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy Int J Radiat Oncol Biol Phys 61 665–677 Occurrence Handle15708244 Occurrence Handle10.1016/j.ijrobp.2004.06.206

    Article  PubMed  Google Scholar 

  7. RD Hofheinz B Gerstenberg-Helldorf Particlevon F Wenz et al. (2005) ArticleTitlePhase I trial of capecitabine and weekly irinotecan in combination with radiotherapy for neoadjuvant therapy of rectal cancer J Clin Oncol 23 1350–1357 Occurrence Handle15684318 Occurrence Handle1:CAS:528:DC%2BD2MXis1Gnu7s%3D Occurrence Handle10.1200/JCO.2005.04.171

    Article  PubMed  CAS  Google Scholar 

  8. VK Mehta C Cho JM Ford et al. (2003) ArticleTitlePhase II trial of preoperative 3D conformal radiotherapy, protracted venous infusion 5-fluorouracil, and weekly CPT-11, followed by surgery for ultrasound-staged T3 rectal cancer Int J Radiat Oncol Biol Phys 55 132–137 Occurrence Handle12504045 Occurrence Handle10.1016/S0360-3016(02)03863-4

    Article  PubMed  Google Scholar 

  9. I Chau G Brown D Cunningham et al. (2006) ArticleTitleNeoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imaging-defined poor-risk rectal cancer J Clin Oncol 24 668–674 Occurrence Handle16446339 Occurrence Handle1:CAS:528:DC%2BD28XhvFKhtLg%3D Occurrence Handle10.1200/JCO.2005.04.4875

    Article  PubMed  CAS  Google Scholar 

  10. V Voelter R Stupp M Matter et al. (2003) ArticleTitlePreoperative hyperfractionated accelerated radiotherapy (HART) and concomitant CPT-11 in locally advanced rectal carcinoma: a phase I study Int J Radiat Oncol Biol Phys 56 1288–1294 Occurrence Handle12873673 Occurrence Handle10.1016/S0360-3016(03)00326-2

    Article  PubMed  Google Scholar 

  11. M Mohiuddin K Winter E Mitchell et al. (2006) ArticleTitleRandomized phase II study of neoadjuvant combined-modality chemoradiation for distal rectal cancer: Radiation Therapy Oncology Group Trial 0012 J Clin Oncol 24 650–655 Occurrence Handle16446336 Occurrence Handle1:CAS:528:DC%2BD28XhvFKhtL0%3D Occurrence Handle10.1200/JCO.2005.03.6095

    Article  PubMed  CAS  Google Scholar 

  12. K Wiltshire J Brierley C Swallow et al. (2004) ArticleTitlePreoperative radiation with concurrent chemotherapy for resectable rectal cancer: effect of dose escalation on pathological complete response, local recurrence free survival & disease free survival Int J Radiat Oncol Biol Phys 60(Suppl) 293 Occurrence Handle10.1016/j.ijrobp.2004.07.090

    Article  Google Scholar 

  13. YH Kim DY Kim TH Kim et al. (2005) ArticleTitleUsefulness of magnetic resonance volumetric evaluation in predicting response to preoperative concurrent chemoradiotherapy in patients with resectable rectal cancer Int J Radiat Oncol Biol Phys 62 761–768 Occurrence Handle15936557 Occurrence Handle10.1016/j.ijrobp.2004.11.005

    Article  PubMed  Google Scholar 

  14. LH Sobin CH Wittenkind (2002) International Union Against Cancer. TNM classification of malignant tumors EditionNumber6 Wiley-Liss New York

    Google Scholar 

  15. O Dworak L Keilholz A Hoffmann (1997) ArticleTitlePathological features of rectal cancer after preoperative radiochemotherapy Int J Colorectal Dis 12 19–23 Occurrence Handle9112145 Occurrence Handle1:STN:280:ByiB28njsFU%3D Occurrence Handle10.1007/s003840050072

    Article  PubMed  CAS  Google Scholar 

  16. SB Lim SC Heo MR Lee et al. (2005) ArticleTitleChanges in outcome with sphincter preserving surgery for rectal cancer in Korea, 1991–2000 Eur J Surg Oncol 31 242–249 Occurrence Handle15780558 Occurrence Handle10.1016/j.ejso.2004.11.011

    Article  PubMed  Google Scholar 

  17. P Therasse SG Arbuck EA Eisenhauer et al. (2000) ArticleTitleNew guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada J Natl Cancer Inst 92 205–216 Occurrence Handle10655437 Occurrence Handle1:STN:280:DC%2BD3c7it1Gitg%3D%3D Occurrence Handle10.1093/jnci/92.3.205

    Article  PubMed  CAS  Google Scholar 

  18. J Widder F Herbst W Dobrowsky et al. (2005) ArticleTitlePreoperative short-term radiation therapy (25 Gy, 2.5 Gy twice daily) for primary resectable rectal cancer (phase II) Br J Cancer 92 1209–1214 Occurrence Handle15785745 Occurrence Handle1:STN:280:DC%2BD2M7nvVGksw%3D%3D Occurrence Handle10.1038/sj.bjc.6602485

    Article  PubMed  CAS  Google Scholar 

  19. MJ O’Connell JA Martenson HS Wieand et al. (1994) ArticleTitleImproving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery N Engl J Med 331 502–507 Occurrence Handle8041415 Occurrence Handle1:STN:280:ByuA3MnisFU%3D Occurrence Handle10.1056/NEJM199408253310803

    Article  PubMed  CAS  Google Scholar 

  20. SR Smalley J Benedetti S Williamson et al. (2004) ArticleTitleIntergroup 0144 a phase III rectal surgical adjuvant study of pelvic radiation (XRT) plus 5-FU based chemotherapy (bolus 5-FU before and after PVI + XRT vs. PVI before, during, and after XRT vs. biochemically modulated bolus 5-FU and XRT): mature outcome results and pelvic failure analysis Int J Radiat Oncol Biol Phys 60 IssueIDSuppl 1 137–138 Occurrence Handle10.1016/j.ijrobp.2004.06.040

    Article  Google Scholar 

  21. DY Kim KH Jung TH Kim et al. (2006) ArticleTitleDoes capecitabine improve tumor response more effectively than 5-fluorouracil/leucovorin in preoperative chemoradiotherapy for locally advanced rectal cancer? Comparative analysis of two prospective phase II trials J Korean Soc Coloproctol 22 IssueIDSuppl 1 102

    Google Scholar 

  22. DW Kim DY Kim TH Kim et al. (2006) ArticleTitleIs T classification still correlated with lymph node status after preoperative chemoradiotherapy for rectal cancer? Cancer 106 1694–1700 Occurrence Handle16532432 Occurrence Handle10.1002/cncr.21794

    Article  PubMed  Google Scholar 

  23. JC Kim TW Kim JH Kim et al. (2005) ArticleTitlePreoperative concurrent radiotherapy with capecitabine before total mesorectal excision in locally advanced rectal cancer Int J Radiat Oncol Biol Phys 63 346–353 Occurrence Handle15913913 Occurrence Handle1:CAS:528:DC%2BD2MXhtVWnsL3E Occurrence Handle10.1016/j.ijrobp.2005.02.046

    Article  PubMed  CAS  Google Scholar 

  24. JF Bosset G Calais L Mineur et al. (2005) ArticleTitleEnhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results-EORTC 22921 J Clin Oncol 23 5620–5627 Occurrence Handle16009958 Occurrence Handle1:CAS:528:DC%2BD2MXhtVersr%2FF Occurrence Handle10.1200/JCO.2005.02.113

    Article  PubMed  CAS  Google Scholar 

  25. Losi L, Luppi G, Gavioli M, et al. Prognostic value of Dworak grade of regression (GR) in patients with rectal carcinoma treated with preoperative radiochemotherapy. Int J Colorectal Dis 2005;1–7.

  26. HD Thames SuffixJr LJ Peters HR Withers et al. (1983) ArticleTitleAccelerated fractionation vs. hyperfractionation: rationales for several treatments per day Int J Radiat Oncol Biol Phys 9 127–138 Occurrence Handle6833014

    PubMed  Google Scholar 

  27. HR Withers (1985) ArticleTitleBiologic basis for altered fractionation schemes Cancer 55 2086–2095 Occurrence Handle3919923 Occurrence Handle1:STN:280:BiqC2M7ms1U%3D Occurrence Handle10.1002/1097-0142(19850501)55:9+<2086::AID-CNCR2820551409>3.0.CO;2-1

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

The authors thank Dr. Kwan Ho Cho, Director of Headquarters in the Korean Radiation Oncology Group (KROG), who constructed the online submission and data management system.

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Authors and Affiliations

  1. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea

    Dae Yong Kim M.D., Tae Hyun Kim M.D., Kyung Hae Jung M.D., Hee Jin Chang M.D., Seok-Byung Lim M.D., Hyo Seong Choi M.D. & Seung-Yong Jeong M.D.

  2. Department of Radiation Oncology, Chonnam National University Hospital, Gwangju, South Korea

    Taek-Keun Nam M.D.

  3. Department of Surgery, Chonnam National University Hospital, Gwangju, South Korea

    Seong Yeob Ryu M.D.

  4. Department of Surgery, Daehang Hospital, Seoul, South Korea

    Doo Suk Lee M.D. & Sung Il Choi M.D.

  5. Department of Medical Oncology, Kangnam St. Mary's Hospital, Seoul, South Korea

    Jin Hyung Kang M.D.

  6. Department of Radiation Oncology, Kangnam St. Mary's Hospital, 505 Banpodong, Seocho-gu, Seoul, 137-040, Republic of Korea

    Sei-Chul Yoon M.D.

Authors
  1. Dae Yong Kim M.D.
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  2. Tae Hyun Kim M.D.
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  6. Hyo Seong Choi M.D.
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  7. Seung-Yong Jeong M.D.
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  8. Taek-Keun Nam M.D.
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  10. Doo Suk Lee M.D.
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  11. Sung Il Choi M.D.
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  12. Jin Hyung Kang M.D.
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  13. Sei-Chul Yoon M.D.
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Corresponding author

Correspondence to Sei-Chul Yoon M.D..

Additional information

Supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (0320320-2).

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Kim, D.Y., Kim, T.H., Jung, K.H. et al. Preoperative Chemoradiotherapy with Concomitant Small Field Boost Irradiation for Locally Advanced Rectal Cancer: A Multi-Institutional Phase II Study (KROG 04-01). Dis Colon Rectum 49, 1684–1691 (2006). https://doi.org/10.1007/s10350-006-0678-z

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  • DOI: https://doi.org/10.1007/s10350-006-0678-z

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