Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, CHUV, 46 rue du Bugnon, 1011, Lausanne, Switzerland.
Radiation Oncology Department, Centre Hospitalier Régional Universitaire Jean Minjoz, INSERM U1098 EFS/BFC, Besançon, France.
J Cancer Res Clin Oncol. 2019 Apr;145(4):1075-1084. doi: 10.1007/s00432-019-02881-8. Epub 2019 Mar 4.
Helical tomotherapy (HT) has been recently introduced in the neoadjuvant treatment of locally advanced rectal cancer. Aim of this study is to report the toxicity and local control rates of a large series of locally advanced rectal cancer patients treated with neoadjuvant chemotherapy and HT under daily image guidance followed by surgery.
Data from 117 locally advanced rectal cancer patients treated at two Swiss Radiotherapy departments were collected and analyzed. Radiotherapy consisted of 45 Gy (1.8 Gy/fraction, 5 fractions/week delivered in 5 weeks) to the regional pelvic lymph nodes. Seventy patients also received a simultaneous integrated boost (SIB) up to 50 Gy to the tumor and involved nodes (2 Gy/fraction, 5 fractions/week delivered in 5 weeks). Chemotherapy consisted of capecitabine 825 mg/m, twice daily, during the irradiation days. After a median interval of 59 days [95% confidence interval (CI) 53-65 days), all patients underwent surgery.
Median follow-up was 45 months (range 4-90 months). The overall rate of acute grade 2-4 toxicity was 18.8% (n = 22). Four patients (3.4%) presented a grade 3 dermatitis (n = 1) or diarrhea (n = 3), and 1 (0.8%) demonstrated grade 4 rectal toxicity. No patients presented with grade ≥ 3 hematologic toxicity. Six patients (5.1%) had late grade 3 gastrointestinal toxicity. The 4-year local control rate was 88.4% (95% CI 87.5-88.5%).
Neoadjuvant chemoradiotherapy delivered with HT under daily image guidance is well tolerated and shows a high 4-year local control rates.
螺旋断层放疗（HT）最近已被引入局部晚期直肠癌的新辅助治疗中。本研究旨在报告在每日图像引导下接受新辅助化疗和 HT 治疗、随后行手术的局部晚期直肠癌患者的毒性和局部控制率。
收集并分析了来自瑞士两个放射治疗部门的 117 例局部晚期直肠癌患者的数据。放疗包括 45 Gy（1.8 Gy/次，5 次/周，5 周内完成）至区域盆腔淋巴结。70 例患者还接受了同步整合增敏（SIB），肿瘤和受累淋巴结达到 50 Gy（2 Gy/次，5 次/周，5 周内完成）。化疗包括卡培他滨 825 mg/m²，每天两次，在放疗期间进行。所有患者在中位间隔 59 天（95%置信区间 [CI] 53-65 天）后接受手术。
中位随访时间为 45 个月（范围 4-90 个月）。急性 2-4 级毒性的总发生率为 18.8%（n=22）。4 例患者（3.4%）出现 3 级皮肤炎（n=1）或腹泻（n=3），1 例（0.8%）出现 4 级直肠毒性。无患者出现≥3 级血液学毒性。6 例（5.1%）患者出现迟发性 3 级胃肠道毒性。4 年局部控制率为 88.4%（95% CI 87.5-88.5%）。
在每日图像引导下接受 HT 治疗的新辅助放化疗耐受性良好，显示出 4 年高局部控制率。
