Journal Article

Treatment Volume, Dose Prescription and Delivery Techniques for Dose-intensification in Rectal Cancer: A National Survey

MANTELLO, GIOVANNA, GUIDA, CESARE, GENOVESI, DOMENICO, FRANZONE, PAOLA, MORGANTI, ALESSIO GIUSEPPE, PIVA, CRISTINA, DEIDDA, MARIA ASSUNTA, IVALDI, GIOVANNI BATTISTA, GASPARINI, LUCREZIA, MONTRONE, SABRINA, MARCHETTI, VANIA, SPATOLA, CORRADO, MUNOZ, FERNANDO, GAMBACORTA, MARIA ANTONIETTA, DONATO, VITTORIO, ZICCARELLI, LUIGI, ROSA, CONSUELO, OSTI, MATTIA FALCHETTO, LUPATTELLI, MARCO, NIESPOLO, RITA MARINA, FACCHIN, FRANCESCA, DI TOMMASO, MONICA, SIMONI, NICOLA, FRANCO, PIERFRANCESCO, CARAVATTA, LUCIANA, CHILOIRO, GIUDITTA, BOSO, CATERINA, PICARDI, VINCENZO

2021

Overview

The aim of the study was to investigate boost volume definition, doses, and delivery techniques for rectal cancer dose intensification. An online survey was made on 25 items (characteristics, simulation, imaging, volumes, doses, planning and treatment). Thirty-eight radiation oncologists joined the study. Twenty-one delivered long-course radiotherapy with dose intensification. Boost volume was delineated on diagnostic magnetic resonance imaging (MRI) in 18 centres (85.7%), and computed tomography (CT) and/or positron emission tomography-CT in 9 (42.8%); 16 centres (76.2%) performed co-registration with CT-simulation. Boost dose was delivered on gross tumor volume in 10 centres (47.6%) and on clinical target volume in 11 (52.4%). The most common total dose was 54-55 Gy (71.4%), with moderate hypofractionation (85.7%). Intensity-modulated radiotherapy (IMRT) was used in all centres, with simultaneous integrated boost in 17 (80.8%) and image-guidance in 18 (85.7%). A high quality of treatment using dose escalation can be inferred by widespread multidisciplinary discussion, MRI-based treatment volume delineation, and radiation delivery relying on IMRT with accurate image-guided radiation therapy protocols.

• Publisher: International Institute of Anticancer Research
• Subject: Cancer / Cancer therapies / Chemotherapy / Colorectal cancer / Computed tomography / Drug dosages / Female / Humans / Interdisciplinary aspects / Italy - epidemiology / Lymphatic Metastasis / Magnetic Resonance Imaging / Male / Medical imaging / Meta-analysis / Neoplasm Staging / Oncology / Patients / Positron emission / Positron emission tomography / Positron Emission Tomography Computed Tomography / Practice Patterns, Physicians' - statistics & numerical data / Questionnaires / Radiation dosage / Radiation therapy / Radiotherapy Dosage / Radiotherapy Planning, Computer-Assisted - adverse effects / Radiotherapy Planning, Computer-Assisted - methods / Radiotherapy Planning, Computer-Assisted - statistics & numerical data / Radiotherapy, Image-Guided - adverse effects / Radiotherapy, Image-Guided - methods / Radiotherapy, Image-Guided - statistics & numerical data / Radiotherapy, Intensity-Modulated - adverse effects / Radiotherapy, Intensity-Modulated - methods / Radiotherapy, Intensity-Modulated - statistics & numerical data / Rectal Neoplasms - diagnosis / Rectal Neoplasms - mortality / Rectal Neoplasms - pathology / Rectal Neoplasms - radiotherapy / Rectum / Schedules / Simulation / Surveys / Surveys and Questionnaires / Survival Analysis / Toxicity / Tumor Burden - physiology / Tumor Burden - radiation effects / Tumors