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 »
- Authors:
-
- Department of Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands)
- Department of Surgery, Catharina Hospital, Eindhoven (Netherlands)
- Department of Surgery, University Hospital Maastricht, Maastricht (Netherlands)
- Department of Radiation Oncology, Catharina Hospital, Eindhoven (Netherlands)
- 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}
}