Abstract：Objective To investigate the feasibility of preoperative neoadjuvant chemoradiotherapy (NCRT) based on volumetric modulated arc therapy (VMAT) for locally advanced rectal cancer (LARC). Methods A retrospective analysis was performed on 162 patients with LARC who received NCRT plus surgery (and postoperative chemotherapy) in our hospital from April 2011 to April 2013. These patients included 113 males and 49 females, with a median age of 56 years (23—84 years). Of all patients, 22, 11, and 5 had stage Ⅱa, Ⅱb, and Ⅱc disease, respectively, and 1, 58, and 65 had stage Ⅲa, Ⅲb, and Ⅲc disease, respectively. All patients received single-arc VMAT, with target doses of 50 Gy/25 fractions for PTV1 and 46 Gy/25 fractions for PTV2, as well as induction and concurrent chemotherapy (median 3 cycles), with Xelox regimen (capecitabine 1000 mg/m2 plus oxaliplatin 100 mg/m2 or 130 mg/m2) as the main chemotherapy protocol. Results All patients received radiotherapy, and only 2 of them discontinued radiotherapy due to grade 3 diarrhea. The overall incidence rates of grade 3 hematological and non-hematological toxicities among all patients during chemoradiotherapy were 9.3% and 16.0%, respectively. Surgery was performed after a median interval of 53.5 days (34—86 days). After surgery, the pathological complete response rate, R0 resection rate, and sphincter preservation rate for low rectal cancer were 30.2%, 100%, and 45.9%, respectively. Among all patients, 16.7% developed postoperative complications, and no one died within 30 days after surgery;85.2%, 87.1%, and 88.9% showed decreases in T stage, N stage, and clinical stage, respectively. Conclusions Preoperative NCRT based on VMAT for LARC is safe and feasible, but its effect on long-term survival needs further observation.
Xiao Lin,Huang Rong,You Kaiyun et al. Study on feasibility of preoperative neoadjuvant chemoradiotherapy based on volumetric modulated arc therapy for locally advanced rectal cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(1): 9-13.
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