1
|
Blache A, Carsuzaa F, Beddok A, Deneuve S, Marcy PY, James D, Dejean C, Dapké S, Devauchelle B, Thariat J. [Issues and implementation of postoperative radiotherapy after flap reconstructive surgery in head and neck cancers]. Bull Cancer 2024; 111:496-504. [PMID: 38553286 DOI: 10.1016/j.bulcan.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 05/13/2024]
Abstract
The management of head and neck cancers is multidisciplinary, often relying on the use of combined treatments to maximize the chances of cure. Combined treatments are however also responsible for cumulative side effects. The aim of reconstructive surgery with a flap is to restore a function lost with the loss of substance from the tumor resection. However, changes in reconstructive surgery have impact of postoperative radiotherapy planning. The optimization of imaging protocols for radiotherapy planning should make it possible to identify postoperative changes and to distinguish flaps from surrounding native tissues to delineate the flaps and document the spontaneous evolution of these flaps or dose-effect relationships in case of radiotherapy. Such changes include atrophy, fibrosis of soft tissue flaps and osteoradionecrosis of bone flaps. Radiotherapy optimization also involves standardization of the definition of target volumes in situations where a flap is present, a situation that is increasingly common in routine care. This evolution of practice, beyond the essential multidisciplinary consultation meetings defining treatment indications, requires a close radio surgical collaboration with respect to technical aspects of the two disciplines. Doing so, anticipation of relapse and toxicity profiles could possibly lead to propose strategies for personalized de-escalation of multimodal treatments through interdisciplinary trials.
Collapse
Affiliation(s)
- Alice Blache
- Département de radiothérapie, centre hospitalier universitaire Amiens-Picardie, 80000 Amiens, France.
| | - Florent Carsuzaa
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | | | - Sophie Deneuve
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Rouen, Poitiers, France
| | - Pierre-Yves Marcy
- Polyclinics ELSAN Group, Department of Radiodiagnostics and Interventional Imaging, PolyClinics Les Fleurs, Quartier Quiez, 83189 Ollioules, France
| | - Dylan James
- Radiotherapy Department, University Hospital of Brest, Brest, France
| | | | - Stéphanie Dapké
- Departement of Maxillofacial Surgery, Research Unit, UR7516 CHIMERE, University of Picardy Jules-Verne, Institut Faire Faces, University Hospital of Amiens Picardy, Amiens Picardy, France
| | - Bernard Devauchelle
- Departement of Maxillofacial Surgery, Research Unit, UR7516 CHIMERE, University of Picardy Jules-Verne, Institut Faire Faces, University Hospital of Amiens Picardy, Amiens Picardy, France
| | - Juliette Thariat
- Department of radiotherapy, Centre François-Baclesse, Corpuscular Physics Laboratory, IN2P3, Ensicaen, CNRS UMR 6534, Université de Normandie, GORTEC, Caen, France
| |
Collapse
|
2
|
Vendrely V, Rivin Del Campo E, Modesto A, Jolnerowski M, Meillan N, Chiavassa S, Serre AA, Gérard JP, Créhanges G, Huguet F, Lemanski C, Peiffert D. Rectal cancer radiotherapy. Cancer Radiother 2021; 26:272-278. [PMID: 34953708 DOI: 10.1016/j.canrad.2021.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We present the updated recommendations of the French society of oncological radiotherapy for rectal cancer radiotherapy. The standard treatment for locally advanced rectal cancer consists in chemoradiotherapy followed by radical surgery with total mesorectal resection and adjuvant chemotherapy according to nodal status. Although this strategy efficiently reduced local recurrences rates below 5% in expert centres, functional sequelae could not be avoided resulting in 20 to 30% morbidity rates. The early introduction of neoadjuvant chemotherapy has proven beneficial in recent trials, in terms of recurrence free and metastasis free survivals. Complete pathological responses were obtained in 15% of tumours treated by chemoradiation, even reaching up to 30% of tumours when neoadjuvant chemotherapy is associated to chemoradiotherapy. These good results question the relevance of systematic radical surgery in good responders. Personalized therapeutic strategies are now possible by improved imaging modalities with circumferential margin assessed by magnetic resonance imaging, by intensity modulated radiotherapy and by refining surgical techniques, and contribute to morbidity reduction. Keeping the same objectives, ongoing trials are now evaluating therapeutic de-escalation strategies, in particular rectal preservation for good responders after neoadjuvant treatment, or radiotherapy omission in selected cases (Greccar 12, Opera, Norad).
Collapse
Affiliation(s)
- V Vendrely
- Service d'oncologie radiothérapie, Hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33600 Pessac, France; Inserm U1035, université de Bordeaux, 33000 Bordeaux, France.
| | - E Rivin Del Campo
- Service d'oncologie radiothérapie, hôpital Tenon, Hôpitaux universitaires Est Parisien, Sorbonne université, 75020 Paris, France
| | - A Modesto
- Service d'oncologie radiothérapie, institut Claudius-Regaud, université de Toulouse, 31000 Toulouse, France
| | - M Jolnerowski
- Service universitaire de radiothérapie, Institut de cancérologie de Lorraine centre Alexis-Vautrin, 54000 Nancy, France
| | - N Meillan
- Service d'oncologie radiothérapie, hôpital Pitié Salpêtrière, APHP, Sorbonne université, 75013 Paris, France
| | - S Chiavassa
- Service de physique médicale, Institut de cancérologie de l'Ouest (ICO) centre René-Gauducheau, 44805 Saint-Herblain, France
| | - A-A Serre
- Service d'oncologie radiothérapie, centre Léon-Bérard, 69000 Lyon, France
| | - J-P Gérard
- Service d'oncologie radiothérapie, centre Antoine-Lacassagne, université Côte d'Azur, 06000 Nice, France
| | - G Créhanges
- Service d'oncologie radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, Hôpitaux universitaires Est Parisien, Sorbonne université, 75020 Paris, France
| | - C Lemanski
- Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, Institut du cancer de Montpellier, université de Montpellier, 34000 Montpellier, France
| | - D Peiffert
- Service universitaire de radiothérapie, Institut de cancérologie de Lorraine centre Alexis-Vautrin, 54000 Nancy, France
| |
Collapse
|
3
|
Grégoire V, Boisbouvier S, Giraud P, Maingon P, Pointreau Y, Vieillevigne L. Management and work-up procedures of patients with head and neck malignancies treated by radiation. Cancer Radiother 2021; 26:147-155. [PMID: 34953696 DOI: 10.1016/j.canrad.2021.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Radiotherapy alone or in association with systemic treatment plays a major role in the treatment of head and neck tumours, either as a primary treatment or as a postoperative modality. The management of these tumours is multidisciplinary, requiring particular care at every treatment step. We present the update of the recommendations of the French Society of Radiation Oncology on the radiotherapy of head and neck tumours from the imaging work-up needed for optimal selection of treatment volume, to optimization of the dose distribution and delivery.
Collapse
Affiliation(s)
- V Grégoire
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon, France.
| | - S Boisbouvier
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - P Maingon
- Département de radiothérapie, Sorbonne Université, groupe hospitalier La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France
| | - Y Pointreau
- Institut interrégional de cancérologie (ILC), centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - L Vieillevigne
- Unité de physique médicale, institut Claudius-Regaud, Institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| |
Collapse
|
4
|
Chen M, Wu S, Zhao W, Zhou Y, Zhou Y, Wang G. Application of deep learning to auto-delineation of target volumes and organs at risk in radiotherapy. Cancer Radiother 2021; 26:494-501. [PMID: 34711488 DOI: 10.1016/j.canrad.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
The technological advancement heralded the arrival of precision radiotherapy (RT), thereby increasing the therapeutic ratio and decreasing the side effects from treatment. Contour of target volumes (TV) and organs at risk (OARs) in RT is a complicated process. In recent years, automatic contouring of TV and OARs has rapidly developed due to the advances in deep learning (DL). This technology has the potential to save time and to reduce intra- or inter-observer variability. In this paper, the authors provide an overview of RT, introduce the concept of DL, summarize the data characteristics of the included literature, summarize the possible challenges for DL in the future, and discuss the possible research directions.
Collapse
Affiliation(s)
- M Chen
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui 233004, China
| | - S Wu
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui 233004, China
| | - W Zhao
- Bengbu Medical College, Bengbu, Anhui 233030, China
| | - Y Zhou
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui 233004, China
| | - Y Zhou
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui 233004, China
| | - G Wang
- Department of Radiation Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui 233004, China.
| |
Collapse
|
5
|
Maingon P, Marchesi V, Azria D, Balosso J, Deutsch E, Cohen Jonathan-Moyal E, Giraud P, Bayart E. RadioTransNet: Preclinical research network coordinated at the SFRO and SFPM. Cancer Radiother 2021; 26:108-115. [PMID: 34862132 DOI: 10.1016/j.canrad.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The RadioTransNet programme launched under the auspices of French societies for radiation oncology (SFRO) and medical physics (SFPM) was approved by the French national cancer institute (INCa) in December 2018 and is dedicated to proposing a relevant national and transversal structure for preclinical research including translational research in radiation oncology with well-defined priority areas of research. Its activities, coordinated by a scientific committee that includes radiation oncologists, medical physicists, academic biologists, are structured around several main areas, i.e.: target volume definition, interaction of radiation with normal tissues, combined treatments and modern dose calculation approaches. Four work packages have been created in these areas and are associated with other objectives pertaining to fundamental radiobiology, early implementation of new drugs in a preclinical setting, contribution of imaging in this task, research in medical physics including transversal components such as medical oncology, radiology, nuclear medicine and also cost/efficiency evaluation. All these tasks will be included in a national network that uses the complementary expertise provided by partners involved in the scheme. Calls for proposals will be selected by the scientific council to be submitted to INCa and the various academic associations to obtain funding for the human and technical resources required to conduct under optimal conditions projects in preclinical and translational research in radiation-oncology.
Collapse
Affiliation(s)
- P Maingon
- Service d'oncologie radiothérapie, groupe hospitalier La Pitié Salpêtrière, APHP, Sorbonne Université, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - V Marchesi
- Unité de radiophysique médicale, Institut de cancérologie de Lorraine, avenue de Bourgogne, CS 30519, 54519 Vandœuvre-lès-Nancy, France
| | - D Azria
- Fédération universitaire d'oncologie radiothérapie Montpellier-Nîmes (Forom), Institut du cancer Montpellier (ICM), IRCM Inserm U1194, université de Montpellier, 34000 Montpellier, France
| | - J Balosso
- Département d'oncologie radiothérapie, centre François-Baclesse, 3, rue du General-Harris, 14000 Caen, France
| | - E Deutsch
- Université Paris-Saclay, Inserm1030 radiothérapie moléculaire, département de radiothérapie Gustave-Roussy, 94805 Villejuif, France
| | - E Cohen Jonathan-Moyal
- Institut universitaire du cancer, Oncopôle, Inserm UMR1037, CRCT, 31000 Toulouse, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - E Bayart
- RadioTransNet, SFRO, 47, rue de la Colonie, 75013 Paris cedex, France; Laboratoire d'optique appliquée, ENSTA-ParisTech, École polytechnique, CNRS-UMR7639, Institut polytechnique de Paris, 828, boulevard des Maréchaux, 91762 Palaiseau cedex, France
| |
Collapse
|
6
|
Mione C, Martin F, Miroir J, Moreau J, Saroul N, Pham Dang N, Bellini R, Lapeyre M, Biau J. Impact of the method chosen for the analysis of recurrences after radiotherapy for head and neck cancers: volume-based, point-based and combined methods. Cancer Radiother 2021; 25:502-506. [PMID: 33762149 DOI: 10.1016/j.canrad.2020.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/21/2020] [Indexed: 11/25/2022]
Abstract
Intensity modulated radiation therapy for head and neck is a complex technique. Inappropriate delineation and/or dose distribution can lead to recurrences. Analysis of these recurrences should lead to improve clinical practice. For several years, different methods of analysis have been described. The purpose of this review is to describe these different methods and to discuss their advantages and limitations. The first published methods used a volume-based approach studying the entire volume of recurrence according to initial target volumes, or dose distribution. The main limitation of these methods was that the volume of recurrence studied was dependent on the delay in diagnosis of that recurrence. Subsequently, other methods used point-based approaches, conceptualizing recurrence either as a spherical expansion from a core of radioresistant cells (center of mass of recurrence volume) or using a more clinical approach, taking into account tumor expansion pathways. More recently, more precise combined methods have been described, combining the different approaches. The choice of method is decisive for conclusions on the origin of recurrence.
Collapse
Affiliation(s)
- C Mione
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - F Martin
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - J Miroir
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - J Moreau
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - N Saroul
- Department of ENT Surgery, Centre Hospitalier Universitaire Hôpital Gabriel Montpied, 58, rue Montalembert, 63003 Clermont Ferrand, France
| | - N Pham Dang
- Department of Maxillo-Facial Surgery, Centre Hospitalier Universitaire Hôpital Estaing, 63003 Clermont-Ferrand, France
| | - R Bellini
- Department of Radiology, Centre Jean Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - M Lapeyre
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - J Biau
- Department of Radiotherapy, Jean-Perrin Centre, 58, rue Montalembert, 63011 Clermont-Ferrand, France.
| |
Collapse
|
7
|
Thureau S, Hapdey S, Vera P. [Role of functional imaging in the definition of target volumes for lung cancer radiotherapy]. Cancer Radiother 2016; 20:699-704. [PMID: 27614514 DOI: 10.1016/j.canrad.2016.08.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 12/23/2022]
Abstract
Functional imaging with positron emission tomography (PET) is interesting to optimize lung radiotherapy planning, and probably to deliver a heterogeneous dose or adapt the radiation dose during treatment. Only fluorodeoxyglucose (FDG) PET-computed tomography (CT) is validated for staging lung cancer and planning radiotherapy. The optimal segmentation methods remain to be defined as well as the interest of "dose painting" from pre-treatment PET (metabolism: FDG) or hypoxia (fluoromisonidazole: FMISO) and the interest of replanning based on pertherapeutic PET.
Collapse
Affiliation(s)
- S Thureau
- Département de médecine nucléaire, centre de lutte contre le cancer Henri-Becquerel, rue d'Amiens, 76000 Rouen, France; Département de radiothérapie et de physique médicale, centre de lutte contre le cancer Henri-Becquerel, rue d'Amiens, 76000 Rouen, France; Laboratoire QuantIF, EA4108-Litis, FR CNRS 3638, 1, rue d'Amiens, 76000 Rouen, France.
| | - S Hapdey
- Département de médecine nucléaire, centre de lutte contre le cancer Henri-Becquerel, rue d'Amiens, 76000 Rouen, France; Laboratoire QuantIF, EA4108-Litis, FR CNRS 3638, 1, rue d'Amiens, 76000 Rouen, France
| | - P Vera
- Département de médecine nucléaire, centre de lutte contre le cancer Henri-Becquerel, rue d'Amiens, 76000 Rouen, France; Laboratoire QuantIF, EA4108-Litis, FR CNRS 3638, 1, rue d'Amiens, 76000 Rouen, France
| |
Collapse
|
8
|
Abstract
Currently, the use of radiation therapy for patients with pancreatic cancer is subject to discussion. In adjuvant setting, the standard treatment is 6 months of chemotherapy with gemcitabine and capecitabine. Chemoradiation (CRT) may improve the survival of patients with incompletely resected tumors (R1). This should be confirmed by a prospective trial. Neoadjuvant CRT is a promising treatment especially for patients with borderline resectable tumors. For patients with locally advanced tumors, there is no a standard. An induction chemotherapy followed by CRT for non-progressive patients reduces the rate of local relapse. Whereas in the first trials of CRT large fields were used, the treated volumes have been reduced to improve tolerance. Tumor movements induced by breathing should be taken in account. Intensity modulated radiation therapy allows a reduction of doses to the organs at risk. Whereas widely used, this technique is not recommended.
Collapse
|
9
|
Thariat J, Clément-Colmou K, Vogin G, Beckendorf V, Ducassou A, Ali AM, Salas S, Saada E, Thyss A, Lapeyre M, Isambert N. [Radiation therapy of cardiac sarcomas]. Cancer Radiother 2014; 18:125-31. [PMID: 24637021 DOI: 10.1016/j.canrad.2014.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/23/2013] [Accepted: 02/05/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE Primary cardiac sarcomas represent less than 10 yearly cases in France. Their median survival is approximately 18 months. The treatment consists of surgery when possible. The role of chemotherapy and radiation therapy is controversial, especially with respect to limiting cardiac radiation dose that is theoretically incompatible with the requirement of a tumoricidal dose for sarcoma. A recent series of 124 cases of the French Sarcoma Group suggested a benefit of radiation therapy on progression-free survival. PATIENTS AND METHODS The dosimetric data of 12 patients were analyzed. RESULTS There was variety in radiotherapy modalities and definition of target volumes, doses and techniques are evolving more conformal plans. Irradiation appeared feasible with conventional fractionation with respect to toxicities (although probably underestimated due to short follow-up and dismal prognosis) and previously demonstrated benefit of radiotherapy for primitive cardiac sarcomas. CONCLUSION A scheme of 45Gy in 1.8Gy per fraction to a preoperative volume with an additional dose of 14Gy in 7 fractions on areas at risk or residual disease and margins 1cm, may be proposed based on the preliminary data of this study. Intensity modulated radiotherapy with daily cone-beam CT-scanner should be evaluated.
Collapse
Affiliation(s)
- J Thariat
- Département d'oncologie-radiothérapie, centre Antoine-Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France; Université Nice Sophia-Antipolis, 06200 Nice, France.
| | - K Clément-Colmou
- Oncologie-radiothérapie, centre René-Gauducheau, institut de cancérologie de l'Ouest, 44805 Saint-Herblain, France
| | - G Vogin
- Oncologie-radiothérapie, centre Alexis-Vautrin, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - V Beckendorf
- Oncologie-radiothérapie, centre Alexis-Vautrin, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - A Ducassou
- Oncologie-radiothérapie, centre Claudius-Regaud, 20-24, rue du Pont-Saint-Pierre, 31300 Toulouse, France
| | - A M Ali
- Clinical oncology, Sohag University, Sohag, Égypte
| | - S Salas
- Oncologie médicale, CHU la Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - E Saada
- Oncologie médicale, centre Antoine-Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - A Thyss
- Oncologie médicale, centre Antoine-Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - M Lapeyre
- Oncologie-radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - N Isambert
- Oncologie médicale, centre Georges-Francois-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| |
Collapse
|
10
|
Huertas A, Marchal F, Peiffert D, Créhange G. [Preoperative radiotherapy for rectal cancer: target volumes]. Cancer Radiother 2013; 17:477-85. [PMID: 24011671 DOI: 10.1016/j.canrad.2013.06.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 06/23/2013] [Indexed: 12/17/2022]
Abstract
Preoperative radiochemotherapy followed by total mesorectal excision is the standard of care for T3-T4-N0 or TxN1 rectal cancer. Defining target volumes relies on the patterns of nodal and locoregional failures. The lower limit of the clinical target volume depends also on the type of surgery. Conformational radiotherapy with or without intensity-modulated radiotherapy implies an accurate definition of volumes and inherent margins in the context of mobile organs such as the upper rectum. Tumoral staging recently improved with newer imaging techniques such as MRI with or without USPIO and FDG-PET-CT. The role of PET-CT remains unclear despite encouraging results and MRI is a helpful tool for a reliable delineation of the gross tumour volume. Co-registration of such modalities with the planning CT may particularly guide radiation oncologists through the gross tumour volume delineation. Acute digestive toxicity can be reduced with intensity modulation radiation therapy. Different guidelines and CT-based atlas regarding the target volumes in rectal cancer give the radiation oncologist a lot of ground for reproducible contours.
Collapse
|