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Title: Three-Dimensional Analysis of Recurrence Patterns in Rectal Cancer: The Cranial Border in Hypofractionated Preoperative Radiotherapy Can Be Lowered

Abstract

Purpose: The aim of this study was to determine whether and where the radiotherapy (RT) clinical target volume (CTV) could be reduced in short-course preoperative treatment of rectal cancer patients. Methods and Materials: Patients treated in the Dutch total mesorectal excision trial, with a local recurrence were analyzed. For 94 (25 who underwent radiation therapy 69 who did not) of 114 patients with a local recurrence, the location of the recurrence was placed in a three-dimensionalthree (3D) model. The data in the 3D model were correlated to the clinical trial data to distinguish a group of patients eligible for CTV reduction. Effects of CTV reduction on dose to the small bowel was tested retrospectively in a dataset of 8 patients with three-field conformal plans and intensity-modulated RT (IMRT). Results: The use of preoperative RT mainly reduces anastomotic, lateral, and perineal recurrences. In patients without primary nodal involvement, no recurrences were found cranially of the S2-S3 interspace, irrespective of the delivery of RT. In patients without primary nodal involvement and a negative circumferential resection margin (CRM), only one recurrence was found cranial to the S2-S3 interspace. With a cranially reduced CTV to the S2-S3 interspace, over 60% reduction in absolute smallmore » bowel exposure at dose levels from 15 to 35 Gy could be achieved with three-field conventional RT, increasing to 80% when IMRT is also added. Conclusions: The cranial border of the CTV can safely be lowered for patients without expected nodal or CRM involvement, yielding a significant reduction of dose to the small bowel. Therefore, a significant reduction of acute and late toxicity can be expected.« less

Authors:
 [1];  [2];  [3];  [4];  [5]
  1. Department of Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands)
  2. Department of Surgery, Catharina Hospital, Eindhoven (Netherlands)
  3. Department of Surgery, University Hospital Maastricht, Maastricht (Netherlands)
  4. Department of Radiation Oncology, Catharina Hospital, Eindhoven (Netherlands)
  5. Department of Radiology, University Hospital Maastricht, Maastricht (Netherlands)
Publication Date:
OSTI Identifier:
21491712
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 80; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2010.01.046; PII: S0360-3016(10)00146-X; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; NEOPLASMS; RADIATION DOSES; RADIOTHERAPY; RECTUM; THREE-DIMENSIONAL CALCULATIONS; BODY; DIGESTIVE SYSTEM; DISEASES; DOSES; GASTROINTESTINAL TRACT; INTESTINES; LARGE INTESTINE; MEDICINE; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; THERAPY

Citation Formats

Nijkamp, Jasper, Kusters, Miranda, Beets-Tan, Regina G.H., Martijn, Hendrik, Beets, Geerard L, Velde, Cornelis J.H. van de, and Marijnen, Corrie A.M., E-mail: marijnen@lumc.n. Three-Dimensional Analysis of Recurrence Patterns in Rectal Cancer: The Cranial Border in Hypofractionated Preoperative Radiotherapy Can Be Lowered. United States: N. p., 2011. Web. doi:10.1016/j.ijrobp.2010.01.046.
Nijkamp, Jasper, Kusters, Miranda, Beets-Tan, Regina G.H., Martijn, Hendrik, Beets, Geerard L, Velde, Cornelis J.H. van de, & Marijnen, Corrie A.M., E-mail: marijnen@lumc.n. Three-Dimensional Analysis of Recurrence Patterns in Rectal Cancer: The Cranial Border in Hypofractionated Preoperative Radiotherapy Can Be Lowered. United States. https://doi.org/10.1016/j.ijrobp.2010.01.046
Nijkamp, Jasper, Kusters, Miranda, Beets-Tan, Regina G.H., Martijn, Hendrik, Beets, Geerard L, Velde, Cornelis J.H. van de, and Marijnen, Corrie A.M., E-mail: marijnen@lumc.n. 2011. "Three-Dimensional Analysis of Recurrence Patterns in Rectal Cancer: The Cranial Border in Hypofractionated Preoperative Radiotherapy Can Be Lowered". United States. https://doi.org/10.1016/j.ijrobp.2010.01.046.
@article{osti_21491712,
title = {Three-Dimensional Analysis of Recurrence Patterns in Rectal Cancer: The Cranial Border in Hypofractionated Preoperative Radiotherapy Can Be Lowered},
author = {Nijkamp, Jasper and Kusters, Miranda and Beets-Tan, Regina G.H. and Martijn, Hendrik and Beets, Geerard L and Velde, Cornelis J.H. van de and Marijnen, Corrie A.M., E-mail: marijnen@lumc.n},
abstractNote = {Purpose: The aim of this study was to determine whether and where the radiotherapy (RT) clinical target volume (CTV) could be reduced in short-course preoperative treatment of rectal cancer patients. Methods and Materials: Patients treated in the Dutch total mesorectal excision trial, with a local recurrence were analyzed. For 94 (25 who underwent radiation therapy 69 who did not) of 114 patients with a local recurrence, the location of the recurrence was placed in a three-dimensionalthree (3D) model. The data in the 3D model were correlated to the clinical trial data to distinguish a group of patients eligible for CTV reduction. Effects of CTV reduction on dose to the small bowel was tested retrospectively in a dataset of 8 patients with three-field conformal plans and intensity-modulated RT (IMRT). Results: The use of preoperative RT mainly reduces anastomotic, lateral, and perineal recurrences. In patients without primary nodal involvement, no recurrences were found cranially of the S2-S3 interspace, irrespective of the delivery of RT. In patients without primary nodal involvement and a negative circumferential resection margin (CRM), only one recurrence was found cranial to the S2-S3 interspace. With a cranially reduced CTV to the S2-S3 interspace, over 60% reduction in absolute small bowel exposure at dose levels from 15 to 35 Gy could be achieved with three-field conventional RT, increasing to 80% when IMRT is also added. Conclusions: The cranial border of the CTV can safely be lowered for patients without expected nodal or CRM involvement, yielding a significant reduction of dose to the small bowel. Therefore, a significant reduction of acute and late toxicity can be expected.},
doi = {10.1016/j.ijrobp.2010.01.046},
url = {https://www.osti.gov/biblio/21491712}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 1,
volume = 80,
place = {United States},
year = {Sun May 01 00:00:00 EDT 2011},
month = {Sun May 01 00:00:00 EDT 2011}
}