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
Artigo
em Inglês
| IBECS
| ID: ibc-159451
Biblioteca responsável:
ES1.1
Localização: 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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Coleções:
Bases de dados nacionais
/
Espanha
Contexto em Saúde:
ODS3 - Saúde e Bem-Estar
Problema de saúde:
Meta 3.8 Atingir a cobertura universal de saúde
Base de dados:
IBECS
Assunto principal:
Neoplasias Retais
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Fluordesoxiglucose F18
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Período Pré-Operatório
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Quimiorradioterapia
Tipo de estudo:
Estudo observacional
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Estudo prognóstico
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Fatores de risco
Limite:
Feminino
/
Humanos
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Masculino
Idioma:
Inglês
Revista:
Clin. transl. oncol. (Print)
Ano de publicação:
2017
Tipo de documento:
Artigo
Instituição/País de afiliação:
Sacro Cuore Don Calabria Cancer Care Center/Italy
/
University of Palermo/Italy