Reduced toxicity in the treatment of locally advanced rectal cancer: a comparison of volumetric modulated arc therapy and 3D conformal radiotherapy
Identifieur interne : 001910 ( Main/Exploration ); précédent : 001909; suivant : 001911Reduced toxicity in the treatment of locally advanced rectal cancer: a comparison of volumetric modulated arc therapy and 3D conformal radiotherapy
Auteurs : Leif Hendrik Dröge [Allemagne] ; Hanne Elisabeth Weber [Allemagne] ; Manuel Guhlich [Allemagne] ; Martin Leu [Allemagne] ; Lena-Christin Conradi [Allemagne] ; Jochen Gaedcke [Allemagne] ; Steffen Hennies [Allemagne] ; Markus Karl Herrmann [Allemagne] ; Margret Rave-Fr Nk [Allemagne] ; Hendrik Andreas Wolff [Allemagne]Source :
- BMC Cancer [ 1471-2407 ] ; 2015.
Abstract
Excellent dosimetric characteristics were demonstrated for volumetric modulated arc therapy (VMAT) in preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC). In a single-center retrospective analysis, we tested whether these advantages may translate into significant clinical benefits. We compared VMAT to conventional 3D conformal radiotherapy (3DCRT) in patients, homogeneously treated according to the control arm of the CAO/ARO/AIO-04 trial.
CRT consisted of pelvic irradiation with 50.4/1.8Gy by VMAT (
Median follow-up was 18.3 months in the VMAT group and 61.5 months in the 3DCRT group with no differences in TRG between them (
VMAT treatment in preoperative CRT for LARC showed the potential to substantially reduce high-grade acute and late toxicity. Importantly, we could demonstrate that VMAT irradiation did not impair short-term oncological results. We conclude, that the reduced toxicity after VMAT irradiation may pave the way for more efficient systemic therapies, and hopefully improved patient survival in the multimodal treatment of LARC.
The online version of this article (doi:10.1186/s12885-015-1812-x) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12885-015-1812-x
PubMed: 26486986
PubMed Central: 4617910
Affiliations:
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Dröge</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Göttingen</settlement></placeName></affiliation></author><author><name sortKey="Weber, Hanne Elisabeth" sort="Weber, Hanne Elisabeth" uniqKey="Weber H" first="Hanne Elisabeth" last="Weber">Hanne Elisabeth Weber</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Göttingen</settlement></placeName></affiliation></author><author><name sortKey="Guhlich, Manuel" sort="Guhlich, Manuel" uniqKey="Guhlich M" first="Manuel" last="Guhlich">Manuel Guhlich</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Göttingen</settlement></placeName></affiliation></author><author><name sortKey="Leu, Martin" sort="Leu, Martin" uniqKey="Leu M" first="Martin" last="Leu">Martin Leu</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Göttingen</settlement></placeName></affiliation></author><author><name sortKey="Conradi, Lena Christin" sort="Conradi, Lena Christin" uniqKey="Conradi L" first="Lena-Christin" last="Conradi">Lena-Christin Conradi</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Göttingen</settlement></placeName></affiliation></author><author><name sortKey="Gaedcke, Jochen" sort="Gaedcke, Jochen" uniqKey="Gaedcke J" first="Jochen" last="Gaedcke">Jochen Gaedcke</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Göttingen</settlement></placeName></affiliation></author><author><name sortKey="Hennies, Steffen" sort="Hennies, Steffen" uniqKey="Hennies S" first="Steffen" last="Hennies">Steffen Hennies</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Göttingen</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff3">Present address: Radiologie München, Burgstrasse 7, 80331 München, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Present address: Radiologie München, Burgstrasse 7, 80331 München</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName></affiliation></author><author><name sortKey="Herrmann, Markus Karl" sort="Herrmann, Markus Karl" uniqKey="Herrmann M" first="Markus Karl" last="Herrmann">Markus Karl Herrmann</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Göttingen</settlement></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff4">MVZ Klinik Dr. Hancken, Strahlentherapie und Radioonkologie, Stade, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>MVZ Klinik Dr. Hancken, Strahlentherapie und Radioonkologie, Stade</wicri:regionArea><wicri:noRegion>Stade</wicri:noRegion><wicri:noRegion>Stade</wicri:noRegion><wicri:noRegion>Stade</wicri:noRegion></affiliation></author><author><name sortKey="Rave Fr Nk, Margret" sort="Rave Fr Nk, Margret" uniqKey="Rave Fr Nk M" first="Margret" last="Rave-Fr Nk">Margret Rave-Fr Nk</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Göttingen</settlement></placeName></affiliation></author><author><name sortKey="Wolff, Hendrik Andreas" sort="Wolff, Hendrik Andreas" uniqKey="Wolff H" first="Hendrik Andreas" last="Wolff">Hendrik Andreas Wolff</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Göttingen</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff3">Present address: Radiologie München, Burgstrasse 7, 80331 München, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Present address: Radiologie München, Burgstrasse 7, 80331 München</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName></affiliation></author></analytic><series><title level="j">BMC Cancer</title><idno type="eISSN">1471-2407</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Excellent dosimetric characteristics were demonstrated for volumetric modulated arc therapy (VMAT) in preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC). In a single-center retrospective analysis, we tested whether these advantages may translate into significant clinical benefits. We compared VMAT to conventional 3D conformal radiotherapy (3DCRT) in patients, homogeneously treated according to the control arm of the CAO/ARO/AIO-04 trial.</p></sec><sec><title>Methods</title><p>CRT consisted of pelvic irradiation with 50.4/1.8Gy by VMAT (<italic>n</italic> = 81) or 3DCRT (<italic>n</italic> = 107) and two cycles of 5-fluorouracil. Standardized total mesorectal excision surgery was performed within 4–6 weeks. The tumor regression grading (TRG) was assessed by the Dworak score. Acute and late toxicity were evaluated via the Common Terminology Criteria for Adverse Events and the Late effects of normal tissues scale, respectively. Side effects greater than or equal to grade 3 were considered high-grade.</p></sec><sec><title>Results</title><p>Median follow-up was 18.3 months in the VMAT group and 61.5 months in the 3DCRT group with no differences in TRG between them (<italic>p</italic> = 0.1727). VMAT treatment substantially reduced high-grade acute and late toxicity, with 5 % versus 20 % (<italic>p</italic> = 0.0081) and 6 % vs. 22 % (<italic>p</italic> = 0.0039), respectively. With regard to specific organs, differences were found in skin reaction (<italic>p</italic> = 0.019) and proctitis (<italic>p</italic> = 0.0153).</p></sec><sec><title>Conclusions</title><p>VMAT treatment in preoperative CRT for LARC showed the potential to substantially reduce high-grade acute and late toxicity. Importantly, we could demonstrate that VMAT irradiation did not impair short-term oncological results. We conclude, that the reduced toxicity after VMAT irradiation may pave the way for more efficient systemic therapies, and hopefully improved patient survival in the multimodal treatment of LARC.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12885-015-1812-x) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Sauer, R" uniqKey="Sauer R">R Sauer</name></author><author><name sortKey="Liersch, T" uniqKey="Liersch T">T Liersch</name></author><author><name sortKey="Merkel, S" uniqKey="Merkel S">S Merkel</name></author><author><name sortKey="Fietkau, R" uniqKey="Fietkau R">R Fietkau</name></author><author><name sortKey="Hohenberger, W" uniqKey="Hohenberger W">W Hohenberger</name></author><author><name sortKey="Hess, C" uniqKey="Hess C">C Hess</name></author><author><name sortKey="Becker, H" 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P">PR Anderson</name></author><author><name sortKey="Li, J" uniqKey="Li J">J Li</name></author><author><name sortKey="Eisenberg, Df" uniqKey="Eisenberg D">DF Eisenberg</name></author><author><name sortKey="Hanlon, Al" uniqKey="Hanlon A">AL Hanlon</name></author><author><name sortKey="Wang, L" uniqKey="Wang L">L Wang</name></author><author><name sortKey="Nicolaou, N" uniqKey="Nicolaou N">N Nicolaou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sun, Lm" uniqKey="Sun L">LM Sun</name></author><author><name sortKey="Huang, Ey" uniqKey="Huang E">EY Huang</name></author><author><name sortKey="Liang, Ja" uniqKey="Liang J">JA Liang</name></author><author><name sortKey="Meng, Fy" uniqKey="Meng F">FY Meng</name></author><author><name sortKey="Chang, Gh" uniqKey="Chang G">GH Chang</name></author><author><name sortKey="Tsao, Mj" uniqKey="Tsao M">MJ Tsao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mell, Lk" uniqKey="Mell L">LK Mell</name></author><author><name sortKey="Kochanski, Jd" uniqKey="Kochanski J">JD Kochanski</name></author><author><name sortKey="Roeske, Jc" uniqKey="Roeske J">JC Roeske</name></author><author><name sortKey="Haslam, Jj" uniqKey="Haslam J">JJ Haslam</name></author><author><name sortKey="Mehta, N" uniqKey="Mehta N">N Mehta</name></author><author><name sortKey="Yamada, Sd" uniqKey="Yamada S">SD Yamada</name></author><author><name sortKey="Hurteau, Ja" uniqKey="Hurteau J">JA Hurteau</name></author><author><name sortKey="Collins, Yc" uniqKey="Collins Y">YC Collins</name></author><author><name sortKey="Lengyel, E" uniqKey="Lengyel E">E Lengyel</name></author><author><name sortKey="Mundt, Aj" uniqKey="Mundt A">AJ Mundt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Emami, B" uniqKey="Emami B">B Emami</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eifel, Pj" uniqKey="Eifel P">PJ Eifel</name></author><author><name sortKey="Levenback, C" uniqKey="Levenback C">C Levenback</name></author><author><name sortKey="Wharton, Jt" uniqKey="Wharton J">JT Wharton</name></author><author><name sortKey="Oswald, Mj" uniqKey="Oswald M">MJ Oswald</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li></country><region><li>Basse-Saxe</li><li>Bavière</li><li>District de Haute-Bavière</li></region><settlement><li>Göttingen</li><li>Munich</li></settlement></list><tree><country name="Allemagne"><region name="Basse-Saxe"><name sortKey="Droge, Leif Hendrik" sort="Droge, Leif Hendrik" uniqKey="Droge L" first="Leif Hendrik" last="Dröge">Leif Hendrik Dröge</name></region><name sortKey="Conradi, Lena Christin" sort="Conradi, Lena Christin" uniqKey="Conradi L" first="Lena-Christin" last="Conradi">Lena-Christin Conradi</name><name sortKey="Gaedcke, Jochen" sort="Gaedcke, Jochen" uniqKey="Gaedcke J" first="Jochen" last="Gaedcke">Jochen Gaedcke</name><name sortKey="Guhlich, Manuel" sort="Guhlich, Manuel" uniqKey="Guhlich M" first="Manuel" last="Guhlich">Manuel Guhlich</name><name sortKey="Hennies, Steffen" sort="Hennies, Steffen" uniqKey="Hennies S" first="Steffen" last="Hennies">Steffen Hennies</name><name sortKey="Hennies, Steffen" sort="Hennies, Steffen" uniqKey="Hennies S" first="Steffen" last="Hennies">Steffen Hennies</name><name sortKey="Herrmann, Markus Karl" sort="Herrmann, Markus Karl" uniqKey="Herrmann M" first="Markus Karl" last="Herrmann">Markus Karl Herrmann</name><name sortKey="Herrmann, Markus Karl" sort="Herrmann, Markus Karl" uniqKey="Herrmann M" first="Markus Karl" last="Herrmann">Markus Karl Herrmann</name><name sortKey="Leu, Martin" sort="Leu, Martin" uniqKey="Leu M" first="Martin" last="Leu">Martin Leu</name><name sortKey="Rave Fr Nk, Margret" sort="Rave Fr Nk, Margret" uniqKey="Rave Fr Nk M" first="Margret" last="Rave-Fr Nk">Margret Rave-Fr Nk</name><name sortKey="Weber, Hanne Elisabeth" sort="Weber, Hanne Elisabeth" uniqKey="Weber H" first="Hanne Elisabeth" last="Weber">Hanne Elisabeth Weber</name><name sortKey="Wolff, Hendrik Andreas" sort="Wolff, Hendrik Andreas" uniqKey="Wolff H" first="Hendrik Andreas" last="Wolff">Hendrik Andreas Wolff</name><name sortKey="Wolff, Hendrik Andreas" sort="Wolff, Hendrik Andreas" uniqKey="Wolff H" first="Hendrik Andreas" last="Wolff">Hendrik Andreas Wolff</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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