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Estimation of second cancer risk after radiotherapy for rectal cancer: comparison of 3D conformal radiotherapy and volumetric modulated arc therapy using different high dose fractionation schemes.

ABSTRACT: To investigate second cancer risk (SCR) comparing volumetric modulated arc therapy (VMAT) and 3D conformal radiotherapy (3DCRT) with different high dose fractionation schemes.VMAT and 3DCRT virtual treatment plans for 25 patients previously treated with radiotherapy for rectal cancer were evaluated retrospectively. Doses prescribed were 25?×?1.8 Gy and 5?×?5 Gy, respectively. SCR was estimated using a carcinogenesis model and epidemiological data for carcinoma and sarcoma induction. SCR was determined by lifetime attributable risk (LAR).Mean excess LAR was highest for organs adjacent to the PTV. Total LAR for VMAT and 3DCRT was 2.3-3.0 and 2.0-2.7 %, respectively. For 5?×?5 Gy, LAR was 1.4-1.9 % for VMAT and 1.2-1.6 % for 3DCRT. Organ-specific excess LAR was significantly higher for VMAT, and highest for bladder and colon. Size and shape of the PTV influenced SCR and was highest for age???40 years. For a patient with an additional lifetime risk of 60 years, LAR was 10 % for 25?×?1.8 Gy and 6 % for 5?×?5 Gy.No statistically significant difference was detected in SCR using VMAT or 3DCRT. For bladder and colon, organ-specific excess LAR was statistically lower using 3DCRT, however the difference was small. Compared to epidemiological data, SCR was smaller when using a hypofractionated schedule. SCR was 2 % higher at normal life expectancy.ClinicalTrials.gov Identifier NCT02572362 . Registered 4 October 2015. Retrospectively registered.

SUBMITTER: Zwahlen DR

PROVIDER: S-EPMC5103599 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Estimation of second cancer risk after radiotherapy for rectal cancer: comparison of 3D conformal radiotherapy and volumetric modulated arc therapy using different high dose fractionation schemes.

Zwahlen Daniel R DR Bischoff Laura I LI Gruber Günther G Sumila Marcin M Schneider Uwe U

Radiation oncology (London, England) 20161110 1

<h4>Purpose</h4>To investigate second cancer risk (SCR) comparing volumetric modulated arc therapy (VMAT) and 3D conformal radiotherapy (3DCRT) with different high dose fractionation schemes.<h4>Methods</h4>VMAT and 3DCRT virtual treatment plans for 25 patients previously treated with radiotherapy for rectal cancer were evaluated retrospectively. Doses prescribed were 25 × 1.8 Gy and 5 × 5 Gy, respectively. SCR was estimated using a carcinogenesis model and epidemiological data for carcinoma and ...[more]

PMID: 27832799

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Project description:BackgroundVolumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) is an advanced form of radiotherapy (RT) technology. The purpose of this study was to report long-term treatment outcomes in patients with locally advanced rectal cancer undergoing VMAT-SIB based concurrent chemoradiotherapy (CRT).MethodsBetween January 2016 and January 2018, a total of 22 patients with operable stage II-III rectal adenocarcinoma were recruited for the pre-designed VMAT-SIB RT protocol. All patients underwent standard diagnostic and staging work-up. The RT target volumes included the following areas: PTV1 = mesorectum that contained gross tumors and enlarged lymph node regions and PTV2 = mesorectum and regional lymphatics from L4-5/S1 to 3-4 cm below the tumor or levator ani muscle, excluding PTV1. The VMAT-SIB dose prescription was as follows: PTV1 = 52.5 Gy/daily 2.1 Gy/25 fractions, PTV2 = 45 Gy/daily 1.8 Gy/25 fractions.ResultsThe mean age of the study population was 64 (range, 18-84) years, and 15 (68.2%) patients were male. Radical operation (total mesorectal excision) was performed by either low anterior resection, ultralow anterior resection, or abdominal perineal resection. All five (22.7%) of the patients with confirmed increasing serum carcinoembryonic antigen (CEA) level at diagnosis showed normalization of serum CEA level after the planned treatment. Among 20 patients who underwent preoperative CRT and surgery, tumor down staging in T- and N-stages was achieved in 10 patients (50%) and 13 patients (65%), respectively, with 20% of ypT0/Tis. With a median follow-up of 54.2 (range, 22.6-61.1) months, the 5-year disease-free survival, overall survival, and local control rates were 64.6%, 81.8%, and 84.4%, respectively. Five patients developed distant metastasis and one developed local recurrence as a first event. Two cases with anastomosis site leakage, three with adhesive ileus, and two with abscess formation were observed during postoperative periods.ConclusionsThe current VMAT-SIB-based CRT protocol provided acceptable treatment and toxicity outcomes.

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Estimation of second cancer risk after radiotherapy for rectal cancer: comparison of 3D conformal radiotherapy and volumetric modulated arc therapy using different high dose fractionation schemes.

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Estimation of second cancer risk after radiotherapy for rectal cancer: comparison of 3D conformal radiotherapy and volumetric modulated arc therapy using different high dose fractionation schemes.

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