Integrated peripheral boost in preoperative radiotherapy for the locally most advanced non-resectable rectal cancer patients

• Published in: Acta oncologica 2013-04, Vol.52 (3), p.528-537
• Main Authors: Radu, Calin, Norrlid, Ola, Brændengen, Morten, Hansson, Karl, Isacsson, Ulf, Glimelius, Bengt
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma - diagnostic imaging; Carcinoma - pathology; Carcinoma - radiotherapy; Carcinoma - surgery; Chemoradiotherapy; Combined Modality Therapy; Disease Progression; Female; Fluorodeoxyglucose F18; Humans; Lymphatic Metastasis; Male; Medicin och hälsovetenskap; Middle Aged; Multimodal Imaging; Neoplasm Invasiveness; Oncology; Onkologi; Positron-Emission Tomography; Preoperative Period; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Adjuvant - adverse effects; Radiotherapy, Conformal - adverse effects; Radiotherapy, Conformal - methods; Rectal Neoplasms - diagnostic imaging; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden
• ISSN: 0284-186X; 1651-226X; 1651-226X
• DOI: 10.3109/0284186X.2012.737022

Abstract Background and Purpose. Few studies have explored the potential clinical advantages of dose escalation and integrated boosts for patients with non-resectable locally advanced rectal cancer. The possibility of escalating dose to non-resectable regions in these patients was the aim of this study. Patients and methods. Seven patients with locally very advanced rectal tumours (sacrum overgrowth or growth into pelvic side walls) were evaluated. Intensity modulated photon and pencil beam scanning proton plans with simultaneously integrated boosts (45 Gy to elective lymph nodes, 50 Gy to tumour and 62.5 Gy to boost area in 25 fractions) were compared. Results. Target coverage was achieved with both photon and proton plans. Estimated risks of acute side effects put the two patients with the largest tumours at unacceptable risk for intestinal toxicity, regardless of modality. The remaining five patients had beneficial sparing of dose to the small intestine with protons. Conclusions. Adding boost to areas where rectal tumours infiltrate adjacent non-resectable organs is an attractive option which appears possible using both photon and proton irradiation. Proton plans reduced dose to organs at risk. Integrated peripheral boosts should be considered more frequently in these very advanced tumours.