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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Neoadjuvant radiotherapy dose escalation for locally advanced rectal cancers in the new era of radiotherapy: A review of literature
Durim Delishaj, Ilaria Costanza Fumagalli, Stefano Ursino, Agostino Cristaudo, Francesco Colangelo, Antonio Stefanelli, Alessandro Alghisi, Giuseppe De Nobili, Romerai D’Amico, Alessandra Cocchi, Antonio Ardizzoia, Carlo Pietro Soatti
Durim Delishaj, Francesco Colangelo, Alessandro Alghisi, Giuseppe De Nobili, Romerai D’Amico, Alessandra Cocchi, Carlo Pietro Soatti, Department of Radiation Oncology, Alessandro Manzoni Hospital, Lecco 23900, Italy
Ilaria Costanza Fumagalli, Department of Radiation Oncology, San Donato Hospital, Milan 20097, Italy
Stefano Ursino, Department of Radiation Oncology, Santa Chiara University Hospital, Pisa 56126, Italy
Agostino Cristaudo, Royal Preston Hospital, Lancashire Teaching Hospital- NHS Tust, Preston PR2 9HT, United Kingdom
Antonio Stefanelli, Department of Radiation Oncology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara 44124, Italy
Antonio Ardizzoia, Department of Clinical Oncology, Alessandro Manzoni Hospital, Lecco 23900, Italy
Author contributions: Delishaj D, Ursino S and Fumagalli CI participate on drafting and searching process of the review; Fumagalli CI, Colangero F, D’Amico R, Alghisi A and De Nobili G contributed on data extraction and screening process of the review; Cocchi A and Stefanelli A revised the review critically for important intellectual content improving scientific value of the manuscript; Cristaudo A proceeded correcting all English grammar errors, improving the scientific value of review and doing the text more fluently and easier to understand from readers and reviewers; Soatti CP and Ardizzoia A give final approval of the review to be submitted and any revised version of manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Durim Delishaj, MD, Doctor, Department of Radiation Oncology, Alessandro Manzoni Hospital, Via Dell’Eremo, 9/11, Lecco 23900, Italy. d.delishaj@asst-lecco.it
Received: April 14, 2021
Peer-review started: April 14, 2021
First decision: June 3, 2021
Revised: June 27, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: October 26, 2021
ARTICLE HIGHLIGHTS
Research background
Preoperative radiochemotherapy had an important role in locally advanced rectal cancers (LARC) improving local and disease control. A benefit on tumor downstaging and pathological complete response (pCR) rate was reported by authors using radiotherapy dose escalation.
Research motivation
Considering the progress of radiation therapy in last decades we decided to analyzed the role of neoadjuvant radiotherapy dose escalation for LARC using innovative radiotherapy techniques such as VMAT, intensity-modulated radiotherapy (IMRT) or image-guided radiotherapy (IGRT).
Research objectives
To evaluate clinical outcomes and toxicity for neoadjuvant radiotherapy dose escalation using innovative radiotherapy techniques.
Research methods
In December 2020 we conducted a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus and Cochrane library. According to PRISMA Group (2009) screening process only studies using radiation doses EQD2 ≥ 54 Gy and VMAT, IMRT or IGRT techniques were analyzed included for the review.
Research results
At the analyses we found high pCR rates (28.2%), local control (92.29%), R0 margins (98.88%) and sphincter preservation rates (76.03%).
Research conclusions
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). G3 or higher toxicity was 11.06 % with no correlation between dose prescription and toxicities.
Research perspectives
We believe that dose escalation neoadjuvant radiotherapy using innovative techniques is safe for LARC and can be considered the standard radiotherapy treatment in a future perspective.
