Clinical implementation of intensity-modulated and image-guided radiotherapy in colorectal cancer

The concept of intensity-modulated and image-guided radiotherapy (IMRT-IGRT) with a simultaneousintegrated boost (SIB) by the TomoTherapy Hi-Art II System in preoperative RTof rectal cancer was implemented in our department. Two pilot studies demonstrated itsability to minimize the setup margin, which led to a significant decrease in the irradiatedvolume of small bowel and bladder. Besides, this technique allows the delivery of a SIB inpatients at high-risk for local failure, this as an alternative strategy to the concomitant administrationof chemotherapy. The synergism of improved dose distributions by IMRT andcorrection of daily treatment uncertainties by IGRT resulted in a limited acute toxicity profileand promising local control in a phase II study with a total accrual of 108 locally advancedrectal cancer patients. Finally, the implementation of this novel modality appeared to be attractivein inoperable oligometastatic colorectal cancer, by displaying a promising responserate and limited toxicity in a phase II trial.

Publication year:2012

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