THREE-DIMENSIONAL ANALYSIS OF RECURRENCE PATTERNS IN RECTAL CANCER: THE CRANIAL BORDER IN HYPOFRACTIONATED PREOPERATIVE RADIOTHERAPY CAN BE LOWERED
THREE-DIMENSIONAL ANALYSIS OF RECURRENCE PATTERNS IN RECTAL CANCER: THE CRANIAL BORDER IN HYPOFRACTIONATED PREOPERATIVE RADIOTHERAPY CAN BE LOWERED
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DOI：
10.1016/j.ijrobp.2010.01.046
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发表时间：
2011-05-01
影响因子：
7
通讯作者：
Marijnen, Corrie A. M.
中科院分区：
文献类型：
--
作者：
Nijkamp, Jasper;Kusters, Miranda;Marijnen, Corrie A. M.
目的：本研究的目的是确定是否和在放疗（RT）的临床靶体积（CTV）可以减少在短期的术前治疗直肠癌patients.Methods和材料：在荷兰全直肠系膜切除试验，局部复发的患者进行了分析。对于114例局部复发患者中的94例（25例接受放射治疗，69例未接受放射治疗），将复发位置置于三维（3D）模型中。将3D模型中的数据与临床试验数据相关联，以区分一组符合CTV降低条件的患者。CTV减少对小肠剂量的影响进行了回顾性测试，在一个数据集的8例患者与三个领域的适形计划和调强RT（IMRT）。结果：术前RT的使用主要减少吻合口，侧，会阴复发。在没有原发性淋巴结受累的患者中，无论是否进行RT，均未发现S2-S3间隙的颅侧复发。在没有原发性淋巴结受累且环形切除边缘（CRM）阴性的患者中，仅发现1例S2-S3间隙的颅侧复发。随着CTV向颅侧减少到S2-S3，间隙，在剂量水平从15到35戈伊时，使用三野常规RT可以实现超过60%的绝对小肠暴露减少，当还添加IMRT时增加到80%。对于没有预期的淋巴结或CRM受累的患者，可以安全地降低CTV的颅侧边缘，从而显著减少小肠的剂量。因此，可以预期急性毒性和风筝毒性会显著降低。(C)2011 Elsevier Inc.
Purpose: The aim of this study was to determine whether and where the radiotherapy (RT) clinical target volume (CTV) could be reduced in short-course preoperative treatment of rectal cancer patients.Methods and Materials: Patients treated in the Dutch total mesorectal excision trial, with a local recurrence were analyzed. For 94 (25 who underwent radiation therapy 69 who did not) of 114 patients with a local recurrence, the location of the recurrence was placed in a three-dimensionalthree (3D) model. The data in the 3D model were correlated to the clinical trial data to distinguish a group of patients eligible for CTV reduction. Effects of CTV reduction on dose to the small bowel was tested retrospectively in a dataset of 8 patients with three-field conformal plans and intensity-modulated RT (IMRT).Results: The use of preoperative RT mainly reduces anastomotic, lateral, and perineal recurrences. In patients without if primary nodal involvement, no recurrences were found cranially of the S2-S3 interspace, irrespective of the delivery of RT. In patients without primary nodal involvement and a negative circumferential resection margin (CRM), only one recurrence was found cranial to the S2-S3 interspace. With a cranially reduced CTV to the S2-S3, interspace, over 60% reduction in absolute small bowel exposure at dose levels from 15 to 35 Gy could be achieved with three-field conventional RT, increasing to 80% when IMRT is also added.Conclusions: The cranial border of the CTV can safely be lowered for patients without expected nodal or CRM involvement, yielding a significant reduction of dose to the small bowel. Therefore, a significant reduction of acute and kite toxicity can be expected. (C) 2011 Elsevier Inc.