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Spatola C, Privitera G, Milazzotto R, Tocco A, Acquaviva G, Marletta F, Marino L, Di Grazia A, Salvo R, Cartia G, Platania A, Molino L, Santacaterina A, Mattace Raso M, Frosina P, Ianni R, Bono M, Liardo L, Bonanno S, La Paglia L, Federico M, Fazio I, Mortellaro G, Ferrera G, Tripoli A, Evangelista G, Daidone A, Biti G, Badalamenti M, Ognibene L, Cacciola A, Parisi S, Pergolizzi S. Trends in combined radio-chemotherapy for locally advanced rectal cancer: a survey among radiation oncology centers of Sicily region on behalf of AIRO. Radiol Med 2019; 124:671-681. [PMID: 30806918 DOI: 10.1007/s11547-019-01007-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/11/2019] [Indexed: 02/08/2023]
Abstract
AIM To conduct a survey among Sicilian centers of radiation oncology belonging to Associazione Italiana di Radioterapia ed Oncologia Clinica (AIRO), to record the different methods of integration of radio-chemotherapy both in neoadjuvant and adjuvant settings, to evaluate surgical procedures in relation to the sphincter preservation and to report the different toxicity profiles of the treatment strategies. METHODS A questionnaire was sent at the end of 2017 to all the radiation oncology centers of Sicily region in order to collect the data from individual centers and the treatment characteristics retrospectively over the previous 5 years, from 2012 to 2016. The required data were collected from 13 centers out of 17 which, in relation to the single catchment areas, correspond to approximately 85% of the Sicilian population. The requested data concerned the type of integrated treatment (neoadjuvant vs adjuvant vs radical), combination with chemotherapy (induction, concomitant, adjuvant), type of surgical intervention (sphincter-saving vs abdomino-perineal resection), disease stage, schedule and radiotherapy technique adopted, as well as toxicity detected over the treatment period. RESULTS A total of 784 pts (M/F: 509/275) were treated between 2012 and 2016, with a median age of 67 years (range 25-92). The majority of patients was treated in the neoadjuvant phase (62% of the total) compared to the adjuvant phase (31%) and to those treated radically (7%). Twenty-five percent of patients did not receive combination chemotherapy mainly for cardiovascular problems. Chemotherapy used concomitantly to radiotherapy was single-agent capecitabine (73% of patients) or 5-fluorouracil (27%). The use of chemotherapy alone before concomitant treatment is more common for patients treated in the adjuvant phase (64% of this subgroup), while 14% of patients treated in the neoadjuvant phase received induction chemotherapy before the concomitant phase; in both cases of chemotherapy alone, the majority of patients (91%) received oxaliplatin-based protocols (FOLFOX/XELOX/CAPOX). Few patients (3%) received chemotherapy alone after the concomitant phase. Information on the surgical treatment received is available for 88% of the sample. Of these, 93% received a surgical treatment. The overall rate of sphincter-saving surgery (anterior resection) was 72%, but the contribution of neoadjuvant treatment allowed to reach a rate of 83% in this subgroup (against 65% found in the subgroup of patients treated in adjuvant phase). Traditional radiotherapy schedule (45-50 Gy in 25-28 fractions) was used in 90% of patients, of which an intensified treatment in neoadjuvant phase (45 Gy + boost of 9-10 Gy) was used in 11% of patients. A short-course regimen (25 Gy in 5 fraction) in neoadjuvant setting was opted rarely (7%). Three-dimensional conformal technique was preferred over intensity-modulated ones (73% vs 27%). Toxicity was mainly of grade I-II CTCAE (skin 23%, gastrointestinal 39%, genitourinary 14%) compared to grade III (gastrointestinal 4%, genitourinary and hematological < 1%). Interestingly, the toxicity rates were significantly higher in the adjuvant group compared to the neoadjuvant (GI: 58% vs 31%, GU: 21% vs 10%). CONCLUSION The present survey shows that in the Sicily region integrated therapies for rectal cancer have allowed a neoadjuvant approach in the majority of patients, thus resulting in a greater use of sphincter conservative surgery. The toxicity has also been reported to be significantly less in this treatment setting.
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Affiliation(s)
- Corrado Spatola
- UOC Radiodiagnostica e Radioterapia, AOU Policlinico-VE Catania, Via S. Sofia 78, 95125, Catania, Italy.
| | - Giuseppe Privitera
- UOC Radiodiagnostica e Radioterapia, AOU Policlinico-VE Catania, Via S. Sofia 78, 95125, Catania, Italy
| | - Roberto Milazzotto
- UOC Radiodiagnostica e Radioterapia, AOU Policlinico-VE Catania, Via S. Sofia 78, 95125, Catania, Italy.,Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, Messina, Italy
| | - Alessandra Tocco
- UOC Radiodiagnostica e Radioterapia, AOU Policlinico-VE Catania, Via S. Sofia 78, 95125, Catania, Italy.,Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, Messina, Italy
| | | | | | | | | | - Rosalba Salvo
- UOC Radioterapia, ASP Caltanissetta, Caltanissetta, Italy
| | | | | | - Laura Molino
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, Messina, Italy.,UOC Radioterapia, AOU Policlinico Messina, Messina, Italy
| | | | | | | | | | - Michele Bono
- UOC Radioterapia, ASP Agrigento, Agrigento, Italy
| | - Luca Liardo
- UOC Radioterapia, ASP Siracusa, Siracusa, Italy
| | | | | | | | - Ivan Fazio
- UOC Radioterapia, CC Macchiarella Palermo, Palermo, Italy
| | | | | | | | | | | | - Giampaolo Biti
- UO Radioterapia, Villa S. Teresa Bagheria, Bagheria, Italy
| | | | - Lucia Ognibene
- UO Radioterapia, Villa S. Teresa Bagheria, Bagheria, Italy
| | - Alberto Cacciola
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, Messina, Italy.,UOC Radioterapia, AOU Policlinico Messina, Messina, Italy
| | - Silvana Parisi
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, Messina, Italy.,UOC Radioterapia, AOU Policlinico Messina, Messina, Italy
| | - Stefano Pergolizzi
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, Messina, Italy.,UOC Radioterapia, AOU Policlinico Messina, Messina, Italy
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