Title: IGRT in rectal cancer
Authors: Ippolito, Edy ×
Mertens, Inge
Haustermans, Karin
Gambacorta, Maria Antonietta
Pasini, Danilo
Valentini, Vincenzo #
Issue Date: 2008
Publisher: Taylor & Francis
Series Title: Acta Oncologica vol:47 issue:7 pages:1317-1324
Abstract: To date, no great interest has been shown in the clinical implementation of recent Image-guided radiation therapy (IGRT) modalities in rectal cancer since only a few studies have been published on this issue. This may be explained by the fact that with current treatment modalities locoregional recurrences are already very low (around 10%). However, there is still room for improvement in treatment of high risk patients (cT3 CRM+, cT4, N+). In these patients better results may be obtained improving radiation technique from 2D to 3D, which showed to be more reliable in terms of target coverage. Also, when higher doses are delivered, Intensity Modulated Radiation Therapy (IMRT) may be used to spare small bowel. But before employing 3D irradiation or IMRT, a proper definition of our clinical target volume (CTV) and planning target volume (PTV) is needed. The CTV should encompass the tumour site, the mesorectum and the lateral nodes, recognized as the most likely sites of local recurrence, with different incidence according to tumour stage. Recent studies discussed the correct delineation of these target volumes in respect of tumour site and stage. From the preliminary results of a study conducted in Rome University 2D planning seemed insufficient to cover the different target volumes especially in T4 patients compared to 3D planning. Also an appropriate PTV margin is necessary in order to manage set-up errors and organ motion. Particularly in these patients, the knowledge of mesorectal movement is required to avoid target missing. Large mesorectal displacements were observed in a study carried out in Leuven University in collaboration with Rome University. A systematic review of the literature together with the data from these first experiences led to the awareness that IGRT could help us to follow the target volume and organs at risk during the treatment, allowing adjustments to improve accuracy in dose delivery, especially when dose escalation studies are planned in the treatment of rectal cancer.
ISSN: 0284-186X
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Laboratory of Experimental Radiotherapy
× corresponding author
# (joint) last author

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