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Retrospective Evaluation of the Impact of Dose Escalation Using Pre-operative Simultaneous Integrated Boost Volumetric Modulated Arc Therapy on the Outcome of Locally Advanced Rectal Cancer Patients

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Abstract

Purpose

Evaluating the outcome of pre-operative simultaneous integrated boost volumetric modulated arc therapy (SIB-VMAT) concomitant with capecitabine in patients diagnosed with locally advanced rectal cancer (LARC) at King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Saudi Arabia, during the period January 2013–December 2019.

Results

A total of 134 patients were enrolled. The median age at diagnosis was 59 years. All patients received pre-operative concurrent chemo-radiation therapy (CCRT) using SIB-VMAT with oral capecitabine. Neoadjuvant chemotherapy was administered prior to CCRT in 32 patients (23.9%). The dose of radiation was 55 Gy in 94 patients (70.1%), while 40 patients (29.9%) received 50 Gy. All patients completed the CCRT treatment without breaks. No records of acute and late grade III and IV toxicities. Curative surgery was performed in all patients with a median interval of 11 (6–52) weeks between the end of CCRT and the date of surgery. No reported 30-day postoperative mortality and no grade III and IV Clavien-Dindo complications. PCR was reported in 26 patients (19.4%), while pathologically negative nodes (pN0) were achieved in 103 patients (76.9%). Adjuvant chemotherapy was utilized in 57 patients (42.5%). The 5-year local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were 93.2%, 67.1%, and 87.3%, respectively. Only tumor regression grade (TRG) was significantly correlated with LRFS, (p value 0.043). On multivariate analysis, only TRG and achievement of pN0 were significantly correlated with DFS (p value < 0.001).

Conclusion

Dose escalation utilization (SIB-VMAT) in the pre-operative treatment of LARC is well tolerated and provides effective local control.

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Data Availability

All data are available with the corresponding author and can be provided upon request.

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Author information

Authors and Affiliations

  1. Section of Radiation Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

    Ahmed Elashwah, Ahmed Awad & Mohammed Alshabanah

  2. Department of Oncology, King Saud University, Riyadh, Saudi Arabia

    Abdullah Alsuhaibani

  3. Section of Colon and Rectal Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

    Alaa Abduljabbar, Nasser Alsanea, Samar Alhomoud & Luai Ashari

  4. Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

    Shouki Bazarbashi, Ali Aljubran & Ahmed Alzahrani

  5. Pathology and Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

    Hadeel Almanea & hussah Alhussini

  6. Kasr Al-Eini Center of Clinical Oncology (NEMROCK), Cairo University, Cairo, Egypt

    Ahmed Elashwah

  7. Radiation Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt

    Ahmed Awad

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  1. Ahmed Elashwah
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Contributions

Material preparation, data collection, and analysis were performed by Ahmed Elashwah, Abdullah Alsuhaibani, and Ahmed Awad (A.E, A.S, and A.A respectively). Surgical management and postoperative follow-up were done by Alaa Abduljabbar, Nasser Alsanea, Samar Alhomoud, and Luai Ashari (A.J, N.A, S.A, L.A respectively). The radiation therapy indications, treatment planning, and follow-up during radiation therapy are done by Abdullah Alsuhaibani, Ahmed Elashwah, and Mohammed Alshabanah (A.S, A.E, and M.A respectively). All chemotherapy indications and treatment were decided by Shouki Bazarbashi, Ali Aljubran, and Ahmed Alzahrani (S.B, A.JUB, Ah. Z respectively). All the histopathological tests and examinations were performed by Hadeel Almanea and Hussah Alhussini (H.A, Hu. A respectively). The first draft of the manuscript was written by Ahmed Elashwah (A.E) and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ahmed Elashwah.

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All methods were carried out in accordance with relevant guidelines and regulations. All experimental protocols were approved by the Research Advisory Council (RAC) and Research ethics committee at the King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (RAC Project # 2161 247). Informed consent was obtained from all subjects and/or their legal guardian(s).

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Elashwah, A., Alsuhaibani, A., Abduljabbar, A. et al. Retrospective Evaluation of the Impact of Dose Escalation Using Pre-operative Simultaneous Integrated Boost Volumetric Modulated Arc Therapy on the Outcome of Locally Advanced Rectal Cancer Patients. J Gastrointest Canc 54, 927–936 (2023). https://doi.org/10.1007/s12029-022-00882-4

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