Neoadjuvant RT dose escalation for LARC in the new era of radiotherapy; a review of literature
PO-1319
Abstract
Neoadjuvant RT dose escalation for LARC in the new era of radiotherapy; a review of literature
Authors: Durim Delishaj1, Stefano Ursino2, Ilaria Costanza Fumagalli3, Agostino Cristaudo4, Alessandra Cocchi1, Antonio Stefanelli5, Carlo Pietro Soatti6
1ASST Lecco, Department of Radiation Oncology, Lecco, Italy; 2Azienda Ospedaliero Universitaria Pisana, Department of Radiation Oncology, pisa, Italy; 3San Donato Hospital, Radiation Oncology Department, San Donato Milanese, Italy; 4Royal Preston Hospital, Lancashire Teaching Hospital- NHS Tust, Radiation oncology department, Preston, United Kingdom; 5Azienda Ospedaliero-Universitaria di Ferrara, Department of Radiotherapy,, Ferrara, Italy; 6ASST Lecco, Department of Radiotherapy, Lecco, Italy
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Purpose or Objective
To analyze the
role of neoadjuvant radiotherapy dose escalation for LARC using innovative
radiotherapy techniques.
Material and Methods
In
December 2020 we conducted a comprehensive literature search of the following
electronic databases: PubMed, Web of Science, Scopus and Cochrane library. The
limit period of research included articles published from January 2009 to
December 2020.Screening by title and abstract was carried out to identifying
only studies using radiation doses EQD2 ≥54 Gy and VMAT, IMRT or IGRT
techniques. The authors’ searches generated a total of 2287 results and,
according to PRISMA Group (2009) screening process, 21 publications fulfil
selection criteria and were included for the review.
Results
The main radiotherapy technique used consisted in VMAT and IGRT modality (74.12 %). The mainly dose prescription was 55 Gy to high risk volume and 45 Gy as prophylactic volume in 25 fractions given with SIB technique (42.85 %).The mean pCR was 28,2 % with no correlation between dose prescribed and response rates (P = >0.5). The R0 margins and sphincter preservation rate were 98.88 % and 76.03, respectively. After a mean follow-up of 35 months local control was 92,29 %. A ≥ G3 toxicity was 11,06 % with no correlation between dose prescription and toxicities. Patients receiving EQD2 dose > 58.9 Gy and BED > 70.7 Gy had higher surgical complications rates compared to other group (p-value= 0.047).
Conclusion
Dose
escalation neoadjuvant radiotherapy using innovative techniques is safe for
LARC achieving higher rates of pCR. EQD2 doses > 58,9 Gy is associated with
higher rate of surgical complications.