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Impact of VMAT-IMRT compared to 3D conformal radiotherapy on anal sphincter dose distribution in neoadjuvant chemoradiation of rectal cancer.
Radiat. Oncol. 13:237 (2018)
BackgroundNeoadjuvant radio- or chemoradiation (nIRT) therapy is the standard treatment for loco-regional advanced rectal cancer patients of the lower or middle third. Currently, intensity modulated radiation therapy (IMRT) is not the recommended radiation technique even though IMRT has advantages compared to 3D-radiation regarding dose sparing to organs at risk like small bowel and urinary bladder. So far, the benefit of IMRT concerning the anal sphincter complex is not examined. With this study we intended to evaluate the dose distribution on the anal sphincters of rectal cancer patients treated with IMRT in comparison with 3D-techniques.MethodsWe selected 16 patients for the IMRT-group and 16 patients for the 3D-group with rectal cancer of the middle third who were treated in our institute. All patients received 45Gy in a chemoradiation protocol. Patients in both groups were matched regarding stage, primary tumor distance to the anal verge and size of the tumor. We delineated the internal and external anal sphincters, the addition of both sphincters and the levator ani muscle in all patients. Subsequently, we evaluated and compared dose parameters of the different sphincters in both groups and analysed the configuration of the isodoses in the area of the caudal radiation field, respectively.ResultsMost of the relevant dose parameters of the caudal sphincters (Dmean, Dmedian, V10-V40) were significantly reduced in the IMRT-group compared to the 3D-group. Accordingly, the isodoses at the caudal edge of the target volume in the IMRT group demonstrated a steep dose fall. The levator ani muscle always was included into the planned target volumes and received the full dose in both groups.ConclusionsThe modern VMAT-IMRT can significantly reduce the dose to the anal sphincters for rectal cancer patients of the middle third who were treated with conventional chemoradiation therapy.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Rectal Cancer ; Anal Sphincter ; Dosimetric Quantification ; Imrt Vs ; 3d-radiation; Target Volume Delineation; Intensity-modulated Radiotherapy; Course Preoperative Radiotherapy; Total Mesorectal Excision; Median Follow-up; Radiation-therapy; Postoperative Chemoradiotherapy; Consensus Guidelines; Irradiated Patients; Bowel Dysfunction
Language
english
Publication Year
2018
HGF-reported in Year
2018
ISSN (print) / ISBN
1748-717X
e-ISSN
1748-717X
Journal
Radiation Oncology
Quellenangaben
Volume: 13,
Issue: 1,
Article Number: 237
Publisher
BioMed Central
Publishing Place
Campus, 4 Crinan St, London N1 9xw, England
Reviewing status
Peer reviewed
Institute(s)
Institute of Radiation Medicine (IRM)
POF-Topic(s)
30203 - Molecular Targets and Therapies
Research field(s)
Radiation Sciences
PSP Element(s)
G-501300-001
WOS ID
WOS:000452082400003
Scopus ID
85057611532
PubMed ID
30509284
Erfassungsdatum
2018-12-11