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Title: Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: Investigating dose-volume relationships and role for inverse planning

Abstract

Purpose: The relationship between volume of irradiated small bowel (VSB) and acute toxicity in rectal cancer radiotherapy is poorly quantified, particularly in patients receiving concurrent preoperative chemoradiotherapy. Using treatment planning data, we studied a series of such patients. Methods and Materials: Details of 41 patients with locally advanced rectal cancer were reviewed. All received 45 Gy in 25 fractions over 5 weeks, 3-4 fields three-dimensional conformal radiotherapy with daily 5-fluorouracil and folinic acid during Weeks 1 and 5. Toxicity was assessed prospectively in a weekly clinic. Using computed tomography planning software, the VSB was determined at 5 Gy dose intervals (V{sub 5}, V{sub 1}, etc.). Eight patients with maximal VSB had dosimetry and radiobiological modeling outcomes compared between inverse and conformal three-dimensional planning. Results: VSB correlated strongly with diarrheal severity at every dose level (p < 0.03), with strongest correlation at lowest doses. Median VSB differed significantly between patients experiencing Grade 0-1 and Grade 2-4 diarrhea (p {<=} 0.05). No correlation was found with anorexia, nausea, vomiting, abdominal cramps, age, body mass index, sex, tumor position, or number of fields. Analysis of 8 patients showed that inverse planning reduced median dose to small bowel by 5.1 Gy (p = 0.008)more » and calculated late normal tissue complication probability (NTCP) by 67% (p = 0.016). We constructed a model using mathematical analysis to predict for acute diarrhea occurring at V{sub 5} and V{sub 15}. Conclusions: A strong dose-volume relationship exists between VSB and acute diarrhea at all dose levels during preoperative chemoradiotherapy. Our constructed model may be useful in predicting toxicity, and this has been derived without the confounding influence of surgical excision on bowel function. Inverse planning can reduce calculated dose to small bowel and late NTCP, and its clinical role warrants further investigation.« less

Authors:
 [1];  [2];  [2];  [3];  [1];  [1];  [1]
  1. Colorectal Cancer Team, Beatson Oncology Centre, Western Infirmary, Glasgow (United Kingdom)
  2. Department of Radiation Physics, Beatson Oncology Centre, Western Infirmary, Glasgow (United Kingdom)
  3. Robertson Centre for Biostatistics, University of Glasgow, Glasgow (United Kingdom)
Publication Date:
OSTI Identifier:
20850128
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 66; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2006.05.005; PII: S0360-3016(06)00813-3; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANOREXIA; COMBINED THERAPY; COMPUTERIZED TOMOGRAPHY; DIARRHEA; DOSIMETRY; IRRADIATION; NAUSEA; NEOPLASMS; PATIENTS; PLANNING; RADIATION DOSES; RADIOTHERAPY; SIMULATION; SURGERY; TOXICITY; URACILS; VOMITING

Citation Formats

Tho, Lye Mun, Glegg, Martin, Paterson, Jennifer, Yap, Christina, MacLeod, Alice, McCabe, Marie, and McDonald, Alexander C. Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: Investigating dose-volume relationships and role for inverse planning. United States: N. p., 2006. Web. doi:10.1016/j.ijrobp.2006.05.005.
Tho, Lye Mun, Glegg, Martin, Paterson, Jennifer, Yap, Christina, MacLeod, Alice, McCabe, Marie, & McDonald, Alexander C. Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: Investigating dose-volume relationships and role for inverse planning. United States. https://doi.org/10.1016/j.ijrobp.2006.05.005
Tho, Lye Mun, Glegg, Martin, Paterson, Jennifer, Yap, Christina, MacLeod, Alice, McCabe, Marie, and McDonald, Alexander C. 2006. "Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: Investigating dose-volume relationships and role for inverse planning". United States. https://doi.org/10.1016/j.ijrobp.2006.05.005.
@article{osti_20850128,
title = {Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: Investigating dose-volume relationships and role for inverse planning},
author = {Tho, Lye Mun and Glegg, Martin and Paterson, Jennifer and Yap, Christina and MacLeod, Alice and McCabe, Marie and McDonald, Alexander C},
abstractNote = {Purpose: The relationship between volume of irradiated small bowel (VSB) and acute toxicity in rectal cancer radiotherapy is poorly quantified, particularly in patients receiving concurrent preoperative chemoradiotherapy. Using treatment planning data, we studied a series of such patients. Methods and Materials: Details of 41 patients with locally advanced rectal cancer were reviewed. All received 45 Gy in 25 fractions over 5 weeks, 3-4 fields three-dimensional conformal radiotherapy with daily 5-fluorouracil and folinic acid during Weeks 1 and 5. Toxicity was assessed prospectively in a weekly clinic. Using computed tomography planning software, the VSB was determined at 5 Gy dose intervals (V{sub 5}, V{sub 1}, etc.). Eight patients with maximal VSB had dosimetry and radiobiological modeling outcomes compared between inverse and conformal three-dimensional planning. Results: VSB correlated strongly with diarrheal severity at every dose level (p < 0.03), with strongest correlation at lowest doses. Median VSB differed significantly between patients experiencing Grade 0-1 and Grade 2-4 diarrhea (p {<=} 0.05). No correlation was found with anorexia, nausea, vomiting, abdominal cramps, age, body mass index, sex, tumor position, or number of fields. Analysis of 8 patients showed that inverse planning reduced median dose to small bowel by 5.1 Gy (p = 0.008) and calculated late normal tissue complication probability (NTCP) by 67% (p = 0.016). We constructed a model using mathematical analysis to predict for acute diarrhea occurring at V{sub 5} and V{sub 15}. Conclusions: A strong dose-volume relationship exists between VSB and acute diarrhea at all dose levels during preoperative chemoradiotherapy. Our constructed model may be useful in predicting toxicity, and this has been derived without the confounding influence of surgical excision on bowel function. Inverse planning can reduce calculated dose to small bowel and late NTCP, and its clinical role warrants further investigation.},
doi = {10.1016/j.ijrobp.2006.05.005},
url = {https://www.osti.gov/biblio/20850128}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 66,
place = {United States},
year = {Sun Oct 01 00:00:00 EDT 2006},
month = {Sun Oct 01 00:00:00 EDT 2006}
}