DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20164524

Conformal radiotherapy in rectal cancer: a dosimetric review

David K. Simson

Abstract


It has been a decade since preoperative chemoradiotherapy is the standard of care in the treatment of rectal cancer. Even though the main picture remains the same, there were many refinements that happened in delivery of chemotherapy, radiotherapy and, of course, surgical skills. Technical advancements in radiotherapy helped us to precisely deliver radiotherapy with minimal side effects. Nevertheless, none of these have been studied in detail to assess the effectiveness and bad effects. It has been noted that modern radiotherapy techniques even though reduces high doses to the critical organ doses, but increases the volume of normal tissues receiving low dose radiation, the adverse effects of the same need to be assessed. There hadn’t been any consensus whether to treat with 3D Conformal Radiotherapy (3DCRT) or Intensity Modulated Radiotherapy (IMRT). This article reviews various dosimetric parameters of various techniques of radiotherapy presently being used in our department which includes conventional, 3DCRT and IMRT.


Keywords


3DCRT, Chemoradiotherapy, Dosimetric review, IMRT, Rectal cancer

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References


Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med. 1985;312:1465-72.

Krook JE, Moertel CG, Gunderson LL, Wieand HS, Collins RT, Beart RW, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med. 1991;324:709-15.

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Eng J Med. 2001;345(9):638.

Folkesson J, Birgisson H, Pahlman L. Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997;336(14):980.

Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. German Rectal Cancer Trial- Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731-40.

Francois Y, Nemoz CJ, Baulieux J, Vignal J, Grandjean JP, Partensky C, et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol. 1999;17:2396.

Valentini V, Coco C, Picciocchi A. Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients. Int J Radiat Oncol Biol Phys. 2002;53:664-74.

Corner C, Khimji F, Tsang Y. Comparison of conventional and three dimensional conformal CT planning techniques for preoperative chemo radiotherapy for locally advanced rectal cancer, Br J Radiol. 2011;84(998):173-8.

Zelefsky MJ, Leibel SA, Gaudin PB, Kutcher GJ, Fleshner NE, Venkatramen ES, et al, Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer, Int J Radiat Oncol Biol Phys. 1998;41(3):491-500.

Koper PC, Stroom JC, van Putten WL, Korevaar GA, Heijmen BJ, Wijnmaalen A, et al, Acute morbidity reduction using 3D-CRT for prostate carcinoma: a randomized study. Int. J Radiat. Oncol. Biol. Phys. 1999;43(4):727-34.

Nutting CM, Convery DJ, Cosgrove VP, Rowbottom C, Padhani AR, Webb S, et al, Reduction of small and large bowel irradiation using an optimized intensity-modulated pelvic radiotherapy technique in patients with prostate cancer, Int. J Radiat. Oncol. Biol. Phys. 2000;48(3):649-56.

Read G, Mott D, Wilkinson JW. Reduction in adverse radiation effect by a simple conformational technique in radiotherapy for early carcinoma of the prostate, British J of Radiol. 1991;64:104-9.

Eisbruch A, Kim HM, Terrell JE, Marsh LH, Dawson LA, Ship JA. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer, Int. J Radiat. Oncol. Biol. Phys. 2001;50(3):695-704.

Chao KS, Low DA, Perez CA, Purdy JA. Intensity-modulated radiation therapy in head and neck cancer: The Mallincrodt experience. Int. J. Cancer. 2000;90:92-103.

Eisbruch A, Marsh LH, Martel MK, Ship JA, Ten Haken R, Pu AT, et al., Comprehensive irradiation of head and neck cancer using conformal multisegmental fields: assessment of target coverage and non-involved tissue sparing. Int. J. Rad. Oncol. Biol. Phys. 1998;41:559-68.

Ling CC, Burman C, Chui CS, Kutcher GJ, Leibel SA, LoSasso T, et al. Conformal radiation treatment of prostate cancer using inversely-planned intensity modulated photon beams produced with dynamic multileaf collimation. Int. J Rad. Oncol. Biol. Phys. 1996;35:721-30.

Nutting CM, Bedford JL, Cosgrove VP, Tait DM, Dearnaley DP, Webb S. Intensity modulated radiotherapy reduces lung irradiation in patients with carcinoma of the esophagus. Front. Radiat. Ther. Oncol. 2002;37:128-31.

Roeske JC, Lujan A, Rotmensch J, Waggoner SE, Yamada D, Mundt AJ. Intensity modulated whole pelvis irradiation in patients with gynaecologic malignancies. Int. J. Rad. Oncol. Biol. Phys. 2000;48:1613-21.

Mundt AJ, Lujan AE, Rotmensch J, Waggoner SE, Yamada SD, Fleming G, et al. Intensity modulated whole pelvic radiotherapy in women with gynecologic malignancies. Int. J. Rad. Oncol. Biol. Phys. 2002;52:1330-7.

Evans PM, Donovan EM, Partridge M, Childs PJ, Convery DJ, Eagle S, et al, The delivery of intensity modulated radiotherapy to the breast using multiple static fields. Radiother. Oncol. 2000;57:79-89.

Tho LM, Glegg M, Paterson J, Yap C, MacLeod A, McCabe M, et al, Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: investigating dose-volume relationships and role for inverse planning. Int J Radiat Oncol Biol Phys. 2006;66(2):505-13.

Baglan KL, Frazier RC, Yan D, Huang RR, Martinez AA, Robertson JM. The dose-volume relationship of acute small bowel toxicity from concurrent 5-FU-based chemotherapy and radiation therapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2002;52(1):176-83.

Emami B. Medicine of IMRT. In: Mund AJ and Roeske JC, ed.Intensity Modulated Radiation Therapy, a Clinical Perspective. Hamilton Ontario: BC Decker Inc. 2005:75-81.

Guerrero Urbano MT, Henrys AJ, Adams EJ, Norman AR, Bedford JL, Harrington KJ, et al, Intensity-modulated radiotherapy in patients with locally advanced rectal cancer reduces volume of bowel treated to high dose levels. Int J Radiat Oncol Biol Phys. 2006;65:907-16.

Arbea L, Ramos LI, Martínez-Monge R, Moreno M, Aristu J. Intensity-modulated radiation therapy (IMRT) vs. 3D conformal radiotherapy (3DCRT) in locally advanced rectal cancer (LARC): dosimetric comparison and clinical implications, Radiat Oncol. 2010;5:17.

Jabbour SK, Patel S, Herman JM. Intensity-Modulated Radiation Therapy for Rectal Carcinoma Can Reduce Treatment Breaks and Emergency Department Visits, International Journal of Surgical Oncology. 2012. Article ID 891067, 7 pages.