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

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] ;  [6] ;  [7]
  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)
  6. Department of Surgery, Leiden University Medical Center, Leiden (Netherlands)
  7. Department of Clinical Oncology, Leiden University Medical Center, Leiden (Netherlands)
Publication Date:
OSTI Identifier:
21491712
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; 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.
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