Radiation dose intensification in pre-operative chemo-radiotherapy for locally advanced rectal cancer
Clin. transl. oncol. (Print)
; 19(2): 189-196, feb. 2017. tab, graf
Artículo
en Inglés
| IBECS
| ID: ibc-159451
Biblioteca responsable:
ES1.1
Ubicación: BNCS
ABSTRACT
Background. To assess the role of radiation dose intensification with simultaneous integrated boost guided by 18-FDG-PET/CT in pre-operative chemo-radiotherapy (ChT-RT) for locally advanced rectal cancer. Methods. A prospective study was approved by the Internal Review Board. Inclusion criteria were age >18 years old, World Health Organization performance status of 0-1, locally advanced histologically proven adenocarcinoma of the rectum within 10 cm of the anal verge, signed specific informed consent. High-dose volumes were defined including the hyper-metabolic areas of 18-FDG-PET/CT of primary tumor and the corresponding mesorectum and/or pelvic nodes with at least a standardized uptake values (SUV) of 5. A dose of 60 Gy/30 fractions was delivered. A total dose of 54 Gy/30 fractions was delivered to prophylactic areas. Capecitabine was administered concomitantly with RT for a dose of 825 mg/mq twice daily for 5 days/every week. Results. Between September 2011 and July 2015 fortypatients were recruited. At the time of the analysis, median follow up was 20 months (range 5-51). The median interval from the end of ChT-RT to surgery was 9 weeks (range 8-12). Thirty-seven patients (92.5 %) were submitted to sphincter preservation. Tumor Regression Grade (Mandard scale) was recorded as follows grade 1 in 7 (17.5 %), grade 2 in 17 (42.5 %), grade 3 in 15 (37.5 %) and grade 4 in 1 (2.5 %). Post-surgical circumferential resection margin was negative in all patients. A tumor downstaging was reported in 62.5 % (95 % CI 0.78-0.47). A nodes downstaging was registered in 85 % (95 % CI 0.55-0.25). 18-FDG-PET/CT was not able to predict pCR. No correlation was found between pre-treatment SUV-max values and pCR. A metabolic tumor volume >127 cc was related to ypT ≥2 (p 0.01). Patients with TRG >2 had higher tumor lesion glycolysis values (p 0.05). Conclusion. Preliminary results did not confirm some advantages in terms of primary tumor downstaging/downsizing compared to conventional schedules reported in historical series. The role of 18-FDG-PET/CT in neoadjuvant rectal cancer management needs to be confirmed in further investigations. Long terms results are necessary (AU)
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Colección:
Bases de datos nacionales
/
España
Contexto en salud:
ODS3 - Salud y Bienestar
Problema de salud:
Meta 3.8: Alcanzar cobertura universal de salud
Base de datos:
IBECS
Asunto principal:
Neoplasias del Recto
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Fluorodesoxiglucosa F18
/
Periodo Preoperatorio
/
Quimioradioterapia
Tipo de estudio:
Estudio observacional
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Estudio pronóstico
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Factores de riesgo
Límite:
Femenino
/
Humanos
/
Masculino
Idioma:
Inglés
Revista:
Clin. transl. oncol. (Print)
Año:
2017
Tipo del documento:
Artículo
Institución/País de afiliación:
Sacro Cuore Don Calabria Cancer Care Center/Italy
/
University of Palermo/Italy