Comparison of acute toxicities between IMRT and VMAT in preoperative concurrent chemoradiotherapy for rectal cancer
Ren Hua, Jin Jing, Xiao Qin, Feng Yan-ru, Fang Hui, Li Ning, Wang Xin, Wang Weihu, Wang Shulian, Song Yongwen, Liu Yueping, Yu Zihao, Liu Xinfan, Dai Jianrong, Li Yexiong
Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
Abstract：Objective To compare the acute toxicities and tolerance between static intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in the preoperative concurrent chemoradiotherapy for rectal cancer. Methods From 2006 to 2013, 242 rectal cancer patients received VMAT (n=61) or IMRT (n=181). The IMRT group was further divided into 7-field IMRT subgroup (n=44) and simplified IMRT (sIMRT) subgroup (n=137). All patients received preoperative radiotherapy to the pelvis at a dose of 50 Gy/25 fractions in 5 weeks, concurrently with capecitabine (1650 mg/m2/day) and oxaliplatin (50 mg/m2/week) for 5 weeks. Comparison between groups was made by grouped t test. Results Nineteen (7.9%) of all patients discontinued radiotherapy due to toxicities, with 4.9% in VMAT group and 8.8% in IMRT group (P=0.325);also, no significant difference in the incidence of toxicities was found between the 7-field IMRT and sIMRT subgroups (8.0% vs 11.4%, P=0.498). The most common acute toxicities in all patients were leucopenia (69.4%, grade ≥3 5.8%), diarrhea (65.5%, grade ≥3 20.7%), and radiodermatitis (62.0%, grade ≥3 7.9%). There were no significant differences in the incidence of most common acute toxicities between the VMAT and IMRT groups (68.9% vs 69.6%, P=0.911;63.9% vs 67.4%, P=0.620;65.6% vs 60.8%, P=0.504), but the VMAT group had a significantly lower incidence of weight loss than the IMRT group (3.3% vs 12.7%, P=0.036). The incidence of most common acute toxicities showed no significant differences between the 7-fieldIMRT and sIMRT subgroups (65.9% vs 70.8%, P=0.539;63.6% vs 68.6%, P=0.540;59.1% vs 61.3%, P=0.793). Among grade ≥3 toxicities, vomiting occurred less frequently in the sIMRT subgroup than in the 7-field IMRT subgroup (0 vs 6.8%, P=0.002). Conclusions For patients with rectal cancer, IMRT and VMAT in preoperative concurrent chemoradiotherapy are well tolerable and lead to similar incidence of acute toxicities. The differences in certain adverse reactions between 7-field IMRT and sIMRT need to be investigated.
Ren Hua,Jin Jing,Xiao Qin et al. Comparison of acute toxicities between IMRT and VMAT in preoperative concurrent chemoradiotherapy for rectal cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(3): 205-209.
[1] Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer[J]. N Engl J Med,2004,351:1731-1740. [2] 耿辉,戴建荣,李晔雄,等.一种简单调强放疗技术应用的初步研究[J].中华放射肿瘤学杂志,2006,15:411-415. [3] 邓垒,李晔雄,金晶,等.简化调强放疗技术应用直肠癌术后放疗的剂量学研究[J].中华放射肿瘤学杂志,2008,17:450-453. [4] 叶序卷,高远红,陈利,等.直肠癌术前五野静态调强(5F-IMRT)和容积弧形调强(VMAT)放疗计划的剂量学特点[J].临床肿瘤学杂志,2012,l7:717-720. [5] Cilla S, Caravatta L, Picardi V, et al. Volumetric modulated arc therapy with simultaneous integrated boost for locally advanced rectal cancer[J]. Clin Oncol,2012,24:261-268. [6] Roel S, Duthoy W, Haustermans K, et al. Definition and delineation of the clinical target volume for rectal cancer[J].Int J Radiat Oncol Biol Phys,2006,65:1129-1142. [7] National Cancer Institute. Common toxicity criteria version 3.0[EB/OL].August 9,1999[2013-09-26].http://ctep.cancer.gov/ protocol Development/ electronic_applications/docs. [8] Aschele C, Cionini L, Lonardi S,et al. Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer:pathologic results of the STAR-01 randomized phase Ⅲ trial[J]. J Clin Oncol,2011,29:2773-2780. [9] Roh MS, Yothers GA, O′Connell MJ, et al. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum:NSABP R-04[J]. J Clin Oncol,2011,29 Suppl:3503. [10] Gérard JP, Azria D, Gourgou-Bourgade S,et al. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer:results of the phase Ⅲ trial ACCORD 12/0405-Prodige 2[J]. J Clin Oncol,2010,28:1638-1644. [11] Rdel C, Liersch T, Becker H, et al. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer:initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial[J]. Lancet Oncol,2012,13:679-687. [12] 金晶,李晔雄,王维虎,等.Ⅱ期和Ⅲ期直肠癌根治术后卡培他滨±奥沙利铂同期放化疗急性副反应比较[J].中华放射肿瘤学杂志,2009,18:200-204. [13] 卢宁宁,金晶,李晔雄,等.Ⅱ期和Ⅲ期直肠癌根治术后卡培他滨同期放化疗疗效及失败原因分析[J].中华放射肿瘤学杂志,2011,20:497-450. [14] 任骅,张可,王绿化,等.简化调强放疗技术应用于局部晚期非小细胞肺癌的剂量学研究[J].中华放射肿瘤学杂志,2009,18:357-360. [15] Jin X, Yi J, Zhou Y, et al. Comparison of whole-field simultaneous integrated boost VMAT and IMRT in the treatment of nasopharyngeal cancer[J].Med Dosim,2013,38:418-423. [16] Seco J, Gu G, Marcelos T, et al. Proton arc reduces range uncertainty effects and improves conformality compared with photon volumetric modulated arc therapy in stereotactic body radiation therapy for non-small cell lung cancer[J].Int J Radiat Oncol Biol Phys,2013,87:188-194. [17] Myrehaug S, Chan G, Craig T, et al. A treatment planning and acute toxicity comparison of two pelvic nodal volume delineation techniques and delivery comparison of intensity-modulated radiotherapy versus volumetric modulated arc therapy for hypofractionated high-risk prostate cancer radiotherapy[J].Int J Radiat Oncol Biol Phys,2012,82:657-662. [18] Kopp RW, Duff M, Catalfamo F, et al. VMAT vs. 7-field-IMRT:assessing the dosimetric parameters of prostate cancer treatment with a 292-patient sample[J]. Med Dosim,2011,36:365-372. [19] Quan EM, Li X, Li Y,et al. A comprehensive comparison of IMRT and VMAT plan quality for prostate cancer treatment[J]. Int J Radiat Oncol Biol Phys,2012,83:1169-1178.
2014, Vol. 23 
