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BMC Cancer

, 15:750

First Online: 20 October 2015Received: 30 April 2015Accepted: 16 October 2015DOI: 10.1186-s12885-015-1812-x

Cite this article as: Dröge, L.H., Weber, H.E., Guhlich, M. et al. BMC Cancer 2015 15: 750. doi:10.1186-s12885-015-1812-x


BackgroundExcellent dosimetric characteristics were demonstrated for volumetric modulated arc therapy VMAT in preoperative chemoradiotherapy CRT for locally advanced rectal cancer LARC. In a single-center retrospective analysis, we tested whether these advantages may translate into significant clinical benefits. We compared VMAT to conventional 3D conformal radiotherapy 3DCRT in patients, homogeneously treated according to the control arm of the CAO-ARO-AIO-04 trial.

MethodsCRT consisted of pelvic irradiation with 50.4-1.8Gy by VMAT n = 81 or 3DCRT n = 107 and two cycles of 5-fluorouracil. Standardized total mesorectal excision surgery was performed within 4–6 weeks. The tumor regression grading TRG was assessed by the Dworak score. Acute and late toxicity were evaluated via the Common Terminology Criteria for Adverse Events and the Late effects of normal tissues scale, respectively. Side effects greater than or equal to grade 3 were considered high-grade.

ResultsMedian follow-up was 18.3 months in the VMAT group and 61.5 months in the 3DCRT group with no differences in TRG between them p = 0.1727. VMAT treatment substantially reduced high-grade acute and late toxicity, with 5 % versus 20 % p = 0.0081 and 6 % vs. 22 % p = 0.0039, respectively. With regard to specific organs, differences were found in skin reaction p = 0.019 and proctitis p = 0.0153.

ConclusionsVMAT treatment in preoperative CRT for LARC showed the potential to substantially reduce high-grade acute and late toxicity. Importantly, we could demonstrate that VMAT irradiation did not impair short-term oncological results. We conclude, that the reduced toxicity after VMAT irradiation may pave the way for more efficient systemic therapies, and hopefully improved patient survival in the multimodal treatment of LARC.

KeywordsRectal cancer Chemoradiotherapy 3D conformal radiotherapy Volumetric modulated arc therapy Tumor regression grading Acute toxicity Late toxicity AbbreviationsVMATVolumetric modulated arc therapy


LARCLocally advanced rectal cancer

3DCRT3D conformal radiotherapy

TRGTumor regression grading

TMETotal mesorectal excision


IMRTIntensity-modulated radiotherapy

CTVClinical target volume

PTVPlanning target volume

Electronic supplementary materialThe online version of this article doi:10.1186-s12885-015-1812-x contains supplementary material, which is available to authorized users.

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Autor: Leif Hendrik Dröge - Hanne Elisabeth Weber - Manuel Guhlich - Martin Leu - Lena-Christin Conradi - Jochen Gaedcke - Steff


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