Technological advances in radiotherapy of rectal cancer: opportunities and challenges
Purpose of review: This review summarizes the available evidence for the use of modern radiotherapy techniques for chemoradiotherapy for rectal cancer, with specific focus on intensity-modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) techniques. Recent findings: The dosimetric benefits of IMRT and VMAT are well established, but prospective clinical studies are limited, with phase I–II studies only. Recent years have seen the publication of a few larger prospective patient series as well as some retrospective cohorts, several of which include much needed late toxicity data. Overall results are encouraging, as toxicity levels – although varying across reports – appear lower than for 3D conformal radiotherapy. Innovative treatment techniques and strategies which may be facilitated by the use of IMRT/VMAT include simultaneously integrated tumour boost, adaptive treatment, selective sparing of specific organs to enable chemotherapy escalation, and nonsurgical management. Summary: Few prospective studies of IMRT and VMAT exist, which causes uncertainty not just in regards to the clinical benefit of these technologies but also in the optimal use. The priority for future research should be subgroups of patients who might receive relatively greater benefit from innovative treatment techniques, such as patients receiving chemoradiotherapy with definitive intent and patients treated with dose escalation.
Conclusions: The intensified treatment paradigm of XELOX concurrent chemoradiation followed by one cycle of consolidation chemotherapy was well tolerated in our cohort and provided a promising long-term oncologic outcome, which warranted further investigation in a randomize trails.
ConclusionsHigh-dose IMRT and chemotherapy followed by FTLE to treat distal rectal cancers are well tolerated and effective. FTLE may improve outcomes and minimize complications in appropriately selected patients. Randomized clinical trials are needed to compare it with standard surgery.
Conclusions: 3D-HDR-BT achieves favorable clinical outcomes with mild late toxicity in patients with locally rNPC. Introduction Nasopharyngeal carcinoma (NPC), a tumor of epithelial origin, is a malignant disease of the head and neck common in southern China, especially in Guangdong province (1). As a result of advances in modern imaging and irradiation techniques, the 5-year overall survival (OS) of patients with newly diagnosed NPC without metastasis has reached 75% after external beam radiotherapy (EBRT) in Asia (2, 3). However, local recurrence, which occurs in 18–40% of patients, remains a major reason for...
Yikan Cheng1†, Yan Ma1†, Jian Zheng1†, Hua Deng2†, Xueqin Wang3,4, Yewei Li3,4, Xiaolin Pang1, Haiyang Chen1, Fang He1, Lei Wang5*, Jianping Wang5* and Xiangbo Wan1* 1Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Department of Radiation Oncology, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China 2Department of Radiation Oncology, Banner-University Medical Center Phoenix, Phoenix, AZ, United States 3Department of Statistical Science, Southern China Center for Statistical Science, School of Mathe...
ConclusionsAdvances in the neoadjuvant treatment of rectal tumors contributed to better rates of complete pathological responses. New paradigms promote an increase in the complete clinical response rates, which would allow organ preservation and consequent reduction of surgical morbidity.ResumoObjetivoDescrever os resultados parciais de estudo em pacientes com câncer de reto submetidos a tratamento neoadjuvante com quimioterapia e radioterapia quanto à taxa resposta clínica completa, sobrevida livre de doença, função anorretal e qualidade de vida.Material e métodosEstudo pros...
CONCLUSIONS: Preoperative short-course CRT is an effective and safe modality. It is clinically comparable to long-course CRT in locally advanced rectal cancer. PMID: 28947986 [PubMed]
Conclusions: Preoperative concurrent capecitabine and dose escalated IMRT is well tolerated and results in high rates of pCR. A randomized trial comparing this regimen with standard 3D conformal chemoradiotherapy is warranted.
Conclusions: CONTRE seems to be a well-tolerated alternative to the current standard treatment sequence. Evaluating its impact on long-term outcomes would require a large randomized trial, but using pathologic response as an endpoint, it could serve as a platform for assessing the addition of novel agents to preoperative treatment in stage II to III rectal cancer.
Conclusion: Endobronchial and endotracheal metastases must be taken into consideration in all the patients with a history of extra-pulmonary cancer. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging, IMRT = intensity-modulated radiotherapy, ESMO = European Society for Medical Oncology, NCCN = National Comprehensive Cancer Network, iv = intravenous, PET - CT = Positron Emission Tomography - Computed Tomography. PMID: 28255381 [PubMed - in process]
This article will explore recent innovations and novel approaches involving radiation therapy to address these issues, including the use of intensity- modulated radiation therapy, avoidance of radical resection with the use of chemoradiation alone, total neoadjuvant chemotherapy with the selective use of chemoradiation, and the use of local excision approaches following neoadjuvant treatment. Although many of these novel strategies appear promisin g, data from prospective randomized trials will be necessary before implementation into standard practice.