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Dosimetric and radiobiological evaluation of four radiation techniques in preoperative rectal cancer radiotherapy

Published online by Cambridge University Press:  20 August 2020

Vasiliki Softa ,
Yiannis Kiouvrekis Open the ORCID record for Yiannis Kiouvrekis [Opens in a new window] ,
Anna Makridou ,
Constantin Kappas ,
George Kyrgias  and
Kiki Theodorou
Vasiliki Softa
Affiliation:
Department of Medical Physics, Medical School, University of Thessaly, Larissa, Greece
Yiannis Kiouvrekis*
Affiliation:
University of Nicosia, Nicosia, Cyprus Department of BioMedical Sciences, University of West Attica, Athens, Greece
Anna Makridou
Affiliation:
Department of Medical Physics, Theageneio Anticancer Hospital, Thessaloniki, Greece
Constantin Kappas
Affiliation:
Department of Medical Physics, Medical School, University of Thessaly, Larissa, Greece
George Kyrgias
Affiliation:
Department of Radiation Oncology, Medical School, University of Thessaly, Larissa, Greece
Kiki Theodorou
Affiliation:
Department of Medical Physics, Medical School, University of Thessaly, Larissa, Greece
*
Address for correspondence: Kiouvrekis Yiannis, Department of BioMedical Sciences, University of West Attica, Athens, Greece. E-mails: [email protected], [email protected], [email protected]
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Abstract

Purpose:

To compare tumour dose distribution, conformality, homogeneity, normal tissue avoidance, tumour control probability (TCP) and normal tissue complication probability (NTCP) using 3D conformal radiation therapy (3DCRT), 3- and 4-field intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with locally advanced rectal cancer.

Materials and methods:

Twenty-four patients staged T1–3N+M0 with locally advanced rectal cancer underwent neoadjuvant chemoradiation therapy. Four different radiotherapy plans were prepared for each patient: 3DCRT, 3- and 4-field IMRT and VMAT are evaluated for target distribution using CI and homogeneity index (HI), normal tissue avoidance using Dmax, V45, V40, V50 and TCP and NTCP using the Lyman–Kutcher–Burman model.

Results:

VMAT has better HI (HI = 1·32) and 3DCRT exhibited better conformality (CI = 1·05) than the other radiotherapy techniques. With regard to normal tissue avoidance, all radiotherapy plans met the constraints. Dmax in the 3DCRT plans was statistically significant (p = 0·04) for bladder and no significant differences in V40 and V50. In the bowel bag, no significant differences in Dmax for any radiotherapy plan and V40 was lower in 3DCRT than VMAT (p = 0·024). In the case of femoral heads, 3DCRT has a statistically significant lower dose on Dmax than 4-field IMRT (p = 0·00 « 0·05). VMAT has the biggest TCP (80·76%) than the other three radiotherapy plans. With regard to normal tissue complications, probabilities were shown to be very low, of the order of 10-14 and 10-41 for bowel bag and femoral heads respectively.

Conclusions:

It can be concluded that 3DCRT plan improves conformity and decreases radiation sparing in the organ at risks, but the VMAT plan exhibits better homogeneity and greater TCP.

Keywords

dosimetric parametersnormal tissue complication probabilitypreoperative radiation therapyrectal cancertumour control probability
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 4 , December 2021 , pp. 398 - 405
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Siegel, RL, Miller, KD, Jemal, A. Cancer statistics, 2019. CA Cancer J Clin 2019; 69 (1): 7–34. doi: 10.3322/caac.21551 CrossRefGoogle ScholarPubMed
Salem, ME, Hartley, M, Unger, K, Marshall, JL. Neoadjuvant combined-modality therapy for locally advanced rectal cancer and its future direction. Oncology (Williston Park) 2016; 30 (6): 546–562.Google ScholarPubMed
Kapiteijn, E, Marijnen, CAM, Nagtegaal, ID et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345 (9): 638–646. doi: 10.1056/NEJMoa010580 CrossRefGoogle ScholarPubMed
Wiggers, T, de Vries, MR, Veeze-Kuypers, B. Surgery for local recurrence of rectal carcinoma. Dis Colon Rectum 1996; 39 (3): 323–328. doi: 10.1007/bf02049476 CrossRefGoogle ScholarPubMed
Holm, T, Cedermark, B, Rutqvist, L-E. Local recurrence of rectal adenocarcinoma after ‘curative’ surgery with and without preoperative radiotherapy. Br J Surg 1994; 81 (3): 452–455. doi: 10.1002/bjs.1800810344 CrossRefGoogle ScholarPubMed
Påhlman, L. improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997; 336 (14): 980–987. doi: 10.1056/NEJM199704033361402 Google Scholar
Frykholm, GJ, Glimelius, B, Påhlman, L. Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum 1993; 36 (6): 564–572. doi: 10.1007/bf02049863 CrossRefGoogle ScholarPubMed
Camma, C, Giunta, M, Fiorica, F, Pagliaro, L, Craxi, A, Cottone, M. Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. J Am Med Assoc 2000; 284 (8): 1008–1015. doi: 10.1001/jama.284.8.1008 CrossRefGoogle ScholarPubMed
Jabbour, SK, Patel, S, Herman, JM et al. Intensity-modulated radiation therapy for rectal carcinoma can reduce treatment breaks and emergency department visits. Int J Surg Oncol 2012; 2012: 7. doi: 10.1155/2012/891067 Google ScholarPubMed
Simson, DK, Mitra, S, Ahlawat, P, Sharma, MK, Yadav, G, Mishra, MB. Dosimetric comparison between intensity modulated radiotherapy and 3 dimensional conformal radiotherapy in the treatment of rectal cancer. Asian Pacific J Cancer Prev 2016; 17 (11): 4935–4937. doi: 10.22034/APJCP.2016.17.11.4935 Google ScholarPubMed
Zhao, J, Hu, W, Cai, G, et al. Dosimetric comparisons of VMAT, IMRT and 3DCRT for locally advanced rectal cancer with simultaneous integrated boost. Oncotarget 2016; 7 (5): 6345–6351. doi: 10.18632/oncotarget.6401 CrossRefGoogle ScholarPubMed
Reyngold, M, Niland, J, ter Veer, A, et al. Trends in intensity modulated radiation therapy use for locally advanced rectal cancer at National Comprehensive Cancer Network centers. Adv Radiat Oncol 2018; 3 (1): 34–41. doi: 10.1016/j.adro.2017.10.001 CrossRefGoogle ScholarPubMed
Liu, L, Wang, H, Yang, R, Wang, J. Dosimetric comparison of fixed-field intensity-modulated radiotherapy and volumetric-modulated arc radiotherapy for preoperative rectal cancer. Precis Radiat Oncol 2018; 2 (2): 39–43. doi: 10.1002/pro6.41 CrossRefGoogle Scholar
Tho, LM, Glegg, M, Paterson, J 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 2006; 66 (2): 505–513. doi: 10.1016/j.ijrobp.2006.05.005 CrossRefGoogle ScholarPubMed
Duthoy, W, De Gersem, W, Vergote, K et al. Clinical implementation of intensity-modulated arc therapy (IMAT) for rectal cancer. Int J Radiat Oncol Biol Phys 2004; 60 (3): 794–806. doi: 10.1016/j.ijrobp.2004.04.016 CrossRefGoogle ScholarPubMed
Richetti, A, Fogliata, A, Clivio, A et al. Neo-adjuvant chemo-radiation of rectal cancer with Volumetric Modulated Arc Therapy: summary of technical and dosimetric features and early clinical experience. Radiat Oncol 2010; 5 (1): 14. doi: 10.1186/1748-717X-5-14 CrossRefGoogle ScholarPubMed
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 (1): 17. doi: 10.1186/1748-717X-5-17 CrossRefGoogle ScholarPubMed
Meier, T, Mascia, A, Wolf, E, Kharofa, J. dosimetric comparison of intensity-modulated proton therapy and volumetric-modulated arc therapy in anal cancer patients and the ability to spare bone Marrow. Int J Part Ther 2017; 4 (2): 11–17. doi: 10.14338/ijpt-17-00017 CrossRefGoogle ScholarPubMed
Rupam, G, Balaji, O, Sereen, RT, Patil, N. Radiation therapy-induced subacute intestinal obstruction. Asian J Pharm Clin Res 2017; 10 (7): 7–8. doi: 10.22159/ajpcr.2017.v10i7.18520 Google Scholar
Martínez Hernández Magro, P. Bowel obstruction secondary to radiation enteritis: a case report. Rev Gastroenterol México (English Ed) 2015; 80 (1): 111–113. doi: 10.1016/j.rgmxen.2015.02.001 Google ScholarPubMed
Li, N, Liu, X, Zhai, F et al. Association between dose-volume parameters and acute bone marrow suppression in rectal cancer patients treated with concurrent chemoradiotherapy. Oncotarget 2017; 8 (54): 92904–92913. doi: 10.18632/oncotarget.21646 CrossRefGoogle ScholarPubMed
Elliott, SP, Malaeb, BS. Long-term urinary adverse effects of pelvic radiotherapy. World J Urol 2011; 29 (1): 35–41. doi: 10.1007/s00345-010-0603-x CrossRefGoogle ScholarPubMed
Fiorino, C, Valdagni, R, Rancati, T, Sanguineti, G. Dose-volume effects for normal tissues in external radiotherapy: pelvis. Radiother Oncol 2009; 93 (2): 153–167. doi: 10.1016/j.radonc.2009.08.004 CrossRefGoogle ScholarPubMed
Mavroidis, P, Pearlstein, KA, Dooley, J et al. Fitting NTCP models to bladder doses and acute urinary symptoms during post-prostatectomy radiotherapy. Radiat Oncol 2018; 13 (1): 17. doi: 10.1186/s13014-018-0961-x CrossRefGoogle ScholarPubMed
Emami, B. Tolerance of normal tissue to irradiation. Int J Radiat Oncol Biol Phys 1991; 21: 109–122.CrossRefGoogle ScholarPubMed