Di Genesio Pagliuca Milena, Turri Lucia, Munoz Fernando, Melano Antonella, Bacigalupo Almalina, Franzone Paola, Sciacero Piera, Tseroni Vassiliki, Vitali Maria Laura, Delmastro Elena, Scolaro Tindaro, Marziano Corrado, Orsatti Marco, Tessa Maria, Rossi Annalisa, Ballare Andrea, Moro Gregorio, Grasso Rachele, Krengli Marco
Radiotherapy, University Hospital Maggiore della Carità, Novara, Italy.
Tumori. 2013 Jan-Feb;99(1):61-7. doi: 10.1177/030089161309900111.
To report the survey about the main aspects on the use of radiotherapy for the treatment of rectal cancer in Piedmont and Liguria.
Sixteen centers (11 from Piedmont and 5 from Liguria) received and answered by email a questionnaire data base about clinical and technical aspects of the treatment of rectal cancer. All data were incorporated in a single data base and analyzed.
Data regarding 593 patients who received radiotherapy for rectal cancer during the year 2009 were collected and analyzed. Staging consisted in colonoscopy, thoracic and abdominal CT, pelvic MRI and endoscopic ultrasound. PET/CT was employed to complete staging and in the treatment planning in 12/16 centers (75%). Neoadjuvant radiotherapy was employed more frequently than adjuvant radiotherapy (50% vs 36.4%), using typically a total dose of 45 Gy with 1.8 Gy/fraction. Concurrent chemoradiation with 5-fluorouracil or capecitabine was mainly employed in neoadjuvant and adjuvant settings, whereas oxaliplatin alone or in combination with 5-FU or capecitabine and leucovorin was commonly employed as the adjuvant agent. The median interval from neoadjuvant treatment to surgery was 7 weeks after long-course radiotherapy and 8 days after short-course radiotherapy. The pelvic total dose of 45 Gy in the adjuvant setting was the same in all the centers. Doses higher than 45 Gy were employed with a radical intent or in case of positive surgical margins. Hypofractionated regimens (2.5, 3 Gy to a total dose of 35-30 Gy) were used in the palliative setting. No relevant differences were observed in target volume definition and patient setup. Twenty-six patients (4.4%) developed grade 3 acute toxicity. Follow-up was scheduled in a similar way in all the centers.
No relevant differences were found among the centers involved in the survey. The approach can help clinicians to address important clinical questions and to improve consistency and homogeneity of treatments.
报告关于皮埃蒙特和利古里亚地区直肠癌放射治疗主要方面的调查。
16个中心（11个来自皮埃蒙特，5个来自利古里亚）通过电子邮件接收并回复了一份关于直肠癌治疗临床和技术方面的问卷数据库。所有数据被纳入一个单一数据库并进行分析。
收集并分析了2009年期间接受直肠癌放射治疗的593例患者的数据。分期包括结肠镜检查、胸部和腹部CT、盆腔MRI和内镜超声检查。12/16个中心（75%）采用PET/CT完成分期并用于治疗计划。新辅助放疗的使用频率高于辅助放疗（50%对36.4%），通常总剂量为45 Gy，每次分割剂量为1.8 Gy。新辅助和辅助治疗中主要采用5-氟尿嘧啶或卡培他滨同步放化疗，而单独使用奥沙利铂或与5-氟尿嘧啶或卡培他滨及亚叶酸联合使用通常作为辅助用药。新辅助治疗至手术的中位间隔时间在长程放疗后为7周，短程放疗后为8天。辅助治疗中盆腔总剂量45 Gy在所有中心相同。高于45 Gy的剂量用于根治性目的或手术切缘阳性的情况。姑息治疗中采用了大分割方案（2.5、3 Gy，总剂量35 - 30 Gy）。在靶区定义和患者摆位方面未观察到相关差异。有26例患者（4.4%）发生3级急性毒性反应。所有中心的随访安排方式相似。
参与调查的各中心之间未发现相关差异。该方法有助于临床医生解决重要的临床问题，并提高治疗的一致性和同质性。
