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Neoadjuvant PET and MRI-based intensity modulated radiotherapy leads to less toxicity and improved pathologic response rates in locally advanced rectal cancer

   
@article{JGO20783,
	author = {John M. David and Gillian Gresham and Salma K. Jabbour and Matthew Deek and Shant Thomassian and John M. Robertson and Neil B. Newman and Joseph M. Herman and Arsen Osipov and Peyman Kabolizadeh and Richard Tuli},
	title = {Neoadjuvant PET and MRI-based intensity modulated radiotherapy leads to less toxicity and improved pathologic response rates in locally advanced rectal cancer},
	journal = {Journal of Gastrointestinal Oncology},
	volume = {9},
	number = {4},
	year = {2018},
	keywords = {},
	abstract = {Background: Neoadjuvant chemoradiation (NeoCRT) is standard of care for the treatment of locally advanced rectal cancer (LARC). Contemporary radiation techniques and pre-treatment imaging may impact toxicities and pathologic response (PR). Herein we compare intensity modulated radiotherapy (IMRT) and advanced pre-treatment imaging in the neoadjuvant treatment of LARC and resulting impact on toxicities and pathologic outcomes relative to 3 dimensional conformal radiotherapy (3DCRT).       
Methods: LARC patients treated at 4 large academic centers in the US from 2007–2016 were reviewed. Patients received 5-FU-based NeoCRT concurrently with IMRT or 3DCRT. PR was recorded as none, partial, or complete. Common terminology for adverse events version 4 was used to grade toxicities. Toxicity rates were compared using Chi-square analysis. Multivariable models were fit adjusting for age, gender, pre-tx CT to identify independent predictors of PR and toxicity.        
Results: A total of 128 patients were analyzed: 60.1% male and 39.8% female, median age 57.7 years (range, 31–85 years). Clinical characteristics were similar across RT groups. The outcome of partial and complete PR was similar for IMRT and 3DCRT (48.1%, 23.1% vs. 31.7%, 23.3%), respectively. After adjusting for gender, age, and pre-RT chemotherapy type, IMRT and pretreatment PET and/or MRI imaging was significantly associated with increased odds for complete and partial response (OR =2.95, 95% CI: 1.21–7.25, P=0.018; OR =14.70, 95% CI: 3.69–58.78, P},
	issn = {2219-679X},	url = {https://jgo.amegroups.org/article/view/20783}
}