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Preoperative three dimensional conformal radiotherapy and volumetric modulated arc therapy concurrently combined with chemotherapy for locally advanced rectum cancer:a five-year follow-up study
Xiao Lin1, Deng Wenjing1, Wei Jiawang2, Xiao Weiwei3, Wang Qiaoxuan3, Zeng Zhifan3, Liu Mengzhong3, Gao Yuanhong3
1Department of Oncology, Jiangmen Central Hospital, Jiangmen 529030, China; 2Department of Oncology, Ganzhou People's Hospital, Ganzhou 341000, China; 3Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
AbstractObjective To compare 5-year overall survival (OS) and disease free survival (DFS) between preoperative three dimensional conformal radiotherapy (3DCRT) and volumetric medulated arc therapy (VMAT) concurrently combined with chemotherapy for locally advanced rectum cancer (LARC), and analyze the value of induction and/or consolidation chemotherapy in these circumstances. Methods 334 patients with LARC treated with preoperative 3DCRT (172 cases) and VMAT (162 cases) concurrently combined with chemotherapy, main protocol XELOX (capecitabine plus oxaplatin), and subsequent surgery in Sun Yat-sen University from May 2007 to April 2013 were retrospectively analyzed. The radiation prescription dose for VMAT group was 50Gy 25 fractions for planning target volume1(PTV1), and 46Gy 25 fractions for PTV2. The radiation prescription dose for 3DCRT group was 46Gy 23 fractions for PTV2. One hundred and eighty-five cases of all received preoperative concurrent chemoradiotherapy (namely, CCRT group), 149 cases received preoperative concurrent chemoradiotherapy plus median 2 courses (1-7 courses) induction and/or consolidation chemotherapy (namely, CCRT±induction chemotherapy±consolidation chemotherapy group), whose main chemotherapy protocol was XELOX. Difference of 5-year OS and DFS between 3DCRT and VMAT group was compared. The rate differences of acute toxicity during chemoradiotherapy, postoperative complications, ypCR, and survival between CCRT group and CCRT±induction chemotherapy±consolidation chemotherapy group were analyzed. Results After a median follow-up of 62.3 months (2.4-119months) for the 334 patients, no any significant difference for 5-year OS (79.0% vs. 83.2%, P=0.442) and 5-year DFS (77.0% vs. 82.1%, P=0.231) between 3DCRT and VMAT group was observed. There was no any significant difference for the Grade 3hematological toxicity (7.0% vs. 12.1%,P=0.114) and non-hematological toxicity (14.1% vs. 16.8%,P=0.491) during chemoradiotherapy, postoperative complications (17.3% vs. 17.4%,P=0.971), ypCR rate (25.4% vs. 30.2%,P=0.329), 5-year OS (80.5% vs. 82.0%,P=0.714) and 5-year DFS (78.8% vs. 81%,P=0.479) between CCRT group and CCRT±induction chemotherapy±consolidation chemotherapy group. Conclusions Compared with 3DCRT, the physics advantage of VMAT technique does not significantly convert into clinical benefits and improve 5-year OS and DFS, even further boosting radiation dose to the gross tumor volume. It is safe for median 2 courses of induction and/or consolidation chemotherapy before and or after preoperative concurrent chemoradiotherapy in the treatment of LARC, though it does not significantly improve ypCR rate and survival.
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2021, Vol. 30 
