Alsuhaibani Abdullah, Elashwah Ahmed, Mahmood Rana, Abduljabbar Alaa, Alhomoud Samar, Ashari Luai, Bazarbashi Shouki, Aljubran Ali, Alzahrani Ahmed, Mohiuddin Muhamed, Almanea Hadeel, Alhussaini Hussah, AlSanea Nasser
Oncology Center ,University Medical City, King Saud University, Riyadh, Saudi Arabia.
Section of Radiation Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
J Gastrointest Cancer. 2018 Jul 14. doi: 10.1007/s12029-018-0133-0.
Assess feasibility-rate of PCR, short-term toxicity after neoadjuvant concurrent chemoradiation (NACRT) delivered via simultaneous integrated boost (SIB) using volumetric modulated arc therapy (VMAT) technique for locally advanced rectal cancer.
Retrospective evaluation of patients with locally advanced rectal cancer treated with VMAT-SIB technique preoperatively at an academic tertiary care center in Riyadh, Saudi Arabia between February 2013 and March 2017.
One hundred patients with depth of invasion staged as T3/T4 or T2 in 93 and seven patients, respectively. Lymph node metastasis was staged as N1/N2 or N0 in 87 and 13 patients, respectively. Circumferential radial margin (CRM) was involved radiologically prior to treatment in 50 patients. A dose of 55 or 50 Gy was given to 71 and 29 patients, respectively. All treatments were completed without interruption. Grade 3/4 toxicity was not observed. Low anterior resection and abdominoperineal resection were performed with negative proximal, distal, and radial margins in 72 and 28 patients, respectively. There were no immediate significant postoperative complications. Histologically, no residual tumor (grade 0) was noted in 20 patients (pCR). Regression grade 1, 2, and 3 were noted in 31, 34, and 15 patients. Average number of lymph nodes retrieved in the surgical specimen was 12 (range 6-22). Lymph nodes were negative for cancer in 80 patients.
Dose escalation with SIB-VMAT as NACRT for rectal cancer is feasible. Moreover, it can increase the rate of pathological complete response with a favorable toxicity profile. Clinical benefit of this approach needs to be validated in a larger cohort of patients with longer follow-up.
评估采用容积调强弧形放疗（VMAT）技术通过同步整合加量（SIB）对局部晚期直肠癌进行新辅助同步放化疗（NACRT）后，PCR的可行性及短期毒性。
回顾性评估2013年2月至2017年3月在沙特阿拉伯利雅得一家学术性三级医疗中心接受术前VMAT-SIB技术治疗的局部晚期直肠癌患者。
100例患者，其中93例侵犯深度分期为T3/T4，7例为T2。分别有87例和13例患者淋巴结转移分期为N1/N2或N0。50例患者在治疗前影像学检查显示环周切缘（CRM）受累。分别有71例和29例患者接受了55或50 Gy的剂量。所有治疗均顺利完成，无中断。未观察到3/4级毒性反应。分别有72例和28例患者进行了低位前切除术和腹会阴联合切除术，近端、远端和切缘均为阴性。术后无即刻严重并发症。组织学检查显示，20例患者无残留肿瘤（0级，pCR）。31例、34例和15例患者分别出现1级、2级和3级消退。手术标本中平均取出的淋巴结数量为12个（范围6 - 22个）。80例患者的淋巴结无癌转移。
采用SIB-VMAT进行剂量递增作为直肠癌的NACRT是可行的。此外，它可以提高病理完全缓解率，且毒性反应良好。这种方法的临床益处需要在更大规模、更长随访时间的患者队列中得到验证。
