PMID- 28830475 OWN - NLM STAT- MEDLINE DCOM- 20180523 LR - 20231104 IS - 1748-717X (Electronic) IS - 1748-717X (Linking) VI - 12 IP - 1 DP - 2017 Aug 22 TI - Preoperative intensity-modulated radiotherapy with a simultaneous integrated boost combined with Capecitabine in locally advanced rectal cancer: short-term results of a multicentric study. PG - 139 LID - 10.1186/s13014-017-0870-4 [doi] LID - 139 AB - BACKGROUND: Preoperative radiotherapy (RT) in combination with fluoropyrimidine-based chemotherapy (CT) is the standard of care in patients with locally advanced, T3-T4 N0-2, rectal cancer (LARC). Given the correlation between RT dose-tumor response and the prognostic role of the tumor regression grade (TRG), treatment intensification represents an area of active investigation. The aim of the study was to analyze the role of RT dose-intensification in the preoperative treatment of LARC in terms of feasibility, efficacy and toxicity. METHODS: We retrospectively analyzed patients with LARC treated with intensity-modulated radiotherapy (IMRT) and simultaneous integrated boost (SIB) at five Italian radiation oncology centers. Concurrent Capecitabine was administered. Treatment response was evaluated in terms of disease down-staging and TRG. Acute toxicity was evaluated according to the CTC-AE 4.0 scale. RESULTS: A total of 76 patients were identified for this analysis. A dose of 45 Gy was prescribed to the entire mesorectum and pelvic lymph nodes with a median SIB dose of 54 Gy (range 52.5-57.5) to the tumor and corresponding mesorectum. Overall, 74/76 (97.4%) patients completed the planned RT, whereas 64/76 (84.2%) patients completed the prescribed CT. Eight (10.5%) patients developed grade 3-4 acute toxicity. Overall, 72/76 patients underwent surgery. The tumor and nodal down-staging was documented in 51 (70.8%) and 43 (67%) patients, respectively. Twenty (27.8%) patients obtained a pathologic complete response. Surgical morbidity was reported in 13/72 patients (18.1%). CONCLUSIONS: Although retrospective in design, this study indicates that IMRT-SIB with a dose range of 52.5-57.5 Gy (median 54 Gy) and concomitant Capecitabine appears feasible, well tolerated and effective in terms of disease down-staging and pathological complete response. Long-term toxicity and the impact on disease control and patient survival will be evaluated with a longer follow-up time. TRIAL REGISTRATION: NA. FAU - Lupattelli, Marco AU - Lupattelli M AUID- ORCID: 0000-0002-5786-5959 AD - Radiation Oncology Dept., Santa Maria della Misericordia Hospital, Piazzale Menghini, 1 - 06129, Perugia, Italy. kiralupis@libero.it. FAU - Matrone, Fabio AU - Matrone F AD - Radiation Oncology Dept., CRO - National Cancer Institute, Aviano, Italy. FAU - Gambacorta, Maria Antonietta AU - Gambacorta MA AD - Radiation Oncology Dept., Catholic University of Sacred Heart, Rome, Italy. FAU - Osti, Mattia AU - Osti M AD - Radiation Oncology Dept., Sant' Andrea Hospital - Sapienza University, Rome, Italy. FAU - Macchia, Gabriella AU - Macchia G AD - Radiation Oncology Dept., Catholic University of Sacred Heart, Campobasso, Italy. FAU - Palazzari, Elisa AU - Palazzari E AD - Radiation Oncology Dept., Santa Maria della Misericordia Hospital - University, Perugia, Italy. FAU - Nicosia, Luca AU - Nicosia L AD - Radiation Oncology Dept., Sant' Andrea Hospital - Sapienza University, Rome, Italy. FAU - Navarria, Federico AU - Navarria F AD - Radiation Oncology Dept., CRO - National Cancer Institute, Aviano, Italy. FAU - Chiloiro, Giuditta AU - Chiloiro G AD - Radiation Oncology Dept., Catholic University of Sacred Heart, Rome, Italy. FAU - Valentini, Vincenzo AU - Valentini V AD - Radiation Oncology Dept., Catholic University of Sacred Heart, Rome, Italy. FAU - Aristei, Cynthia AU - Aristei C AD - Radiation Oncology Dept., Santa Maria della Misericordia Hospital - University, Perugia, Italy. FAU - De Paoli, Antonino AU - De Paoli A AD - Radiation Oncology Dept., CRO - National Cancer Institute, Aviano, Italy. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20170822 PL - England TA - Radiat Oncol JT - Radiation oncology (London, England) JID - 101265111 RN - 0 (Antineoplastic Agents) RN - 6804DJ8Z9U (Capecitabine) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Antineoplastic Agents/administration & dosage/adverse effects MH - Capecitabine/administration & dosage/adverse effects MH - Chemoradiotherapy, Adjuvant/adverse effects/*methods MH - Female MH - Humans MH - Male MH - Middle Aged MH - Neoadjuvant Therapy/adverse effects/*methods MH - Radiotherapy, Intensity-Modulated/adverse effects/*methods MH - Rectal Neoplasms/drug therapy/*radiotherapy MH - Retrospective Studies PMC - PMC5568311 OTO - NOTNLM OT - Capecitabine OT - Imrt-sib OT - Pre-operative chemo-radiotherapy OT - Rectal cancer COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study was retrospectively approved by the Ethics Committee (Comitato Etico Unico Regionale www.egas.sanita.fvg.it; on April 5, 2017; Ref. n. 9628; study number: CRO-2017-06). CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/08/24 06:00 MHDA- 2018/05/24 06:00 PMCR- 2017/08/22 CRDT- 2017/08/24 06:00 PHST- 2017/04/11 00:00 [received] PHST- 2017/08/10 00:00 [accepted] PHST- 2017/08/24 06:00 [entrez] PHST- 2017/08/24 06:00 [pubmed] PHST- 2018/05/24 06:00 [medline] PHST- 2017/08/22 00:00 [pmc-release] AID - 10.1186/s13014-017-0870-4 [pii] AID - 870 [pii] AID - 10.1186/s13014-017-0870-4 [doi] PST - epublish SO - Radiat Oncol. 2017 Aug 22;12(1):139. doi: 10.1186/s13014-017-0870-4.