Feasibility Study Using Pre-operative Prone-position Volumetric Modulated Arc Therapy and Chemotherapy in Locally Advanced Rectal Cancer

術前俯臥弧形調控放射治療合併化學治療於局部嚴重性直腸癌之可行性研究

王嘉儁(Chia-Chun Wang) ； 蔡巧琳(Chiao-Ling Tsai) ； 陳育瑄(Yu-Hsuan Chen) ； 梁金銅(Jin-Tung Liang) ； 謝銘鈞(Ming-Jium Shieh) ； 林本仁(Ben-Ren Lin) ； 林育麟(Yu-Lin Lin) ； 成佳憲(Jason Chia-Hsien Cheng)

《放射治療與腫瘤學》 20卷1期 (2013/03) Pp. 13-22

https://doi.org/10.6316/TRO/201320(1)13

摘要

目的：評估術前俯臥弧形調控放射治療合併化學治療，於局部嚴重性直腸癌病患之治療副作用以及初步治療成效。材料與方法：自西元2010年 4月至2010年10月，十位臨床分期為二至四期之直腸癌病患接受了術前俯臥弧形調控放射治療合併化學治療。所有病患皆使用腹板（belly board）以及漲尿治療。所有治療計畫皆是45 Gy分25次治療，並以Pinnacle^3 9.0軟體設計。擺位誤差以至少每週一次的錐束電腦斷層（cone-beam computed tomography）校正。治療之副作用以Common Terminolo Criteria for Adverse Events v4.0作為評估工具。化學治療主要以5-fluorouracil搭配oxaliplatin 或是mitomycin。五位病患同時使用了bevacizumab。結果：所有的病人皆完成了術前合併放射化學治療，也都接受了手術切除。兩位使用bevacizumab的病人達到了病理完全反應（pathological complete response）。九位病人達到了病理上的期別下降（downstaging）。只有一個病人病理上有淋巴結的轉移。最常見的副作用是第一級或第二級的肛門皮膚反應或腹瀉。沒有任何病患有第三級或以上的副作用。病患的副作用和是否使用bevacizumab 無關。平均擺位誤差在頭腳、左右及前後方向分別為0.24公分、0.21公分及0.37 公分。擺位誤差之標準差之範圍在頭腳、左右及前後方向分別為0.09-0.34公分、0.06-0.20公分及0.11-0.52公分。結論：不論是否合併使用bevacizumab，術前俯臥弧形調控放射治療合併化學治療是可行且安全的。治療造成的副作用在可接受的範圍，治療之反應也有不錯的成效。俯臥姿勢需要多注意擺位誤差的校正。

關鍵字

直腸癌 ； 俯臥 ； 弧形調控放射治療

並列摘要

Purpose: To evaluate the toxicity and treatment response of using volumetric modulated arc therapy (VMAT) and chemotherapy as neoadjvuant concurrent chemoradiotherapy (CCRT) for rectal cancer.Materials and Methods: Ten patients with stage IIA-IV rectal adenocarcinoma who underwent neoadjuvant CCRT using prone-position VMAT from April 2010 to December 2010 were enrolled in this study. All patients were treated on a belly board with a full bladder. All VMAT plans were designed with the Pinnacle3 9.0 planning system with 45 Gy in 25 fractions. Setup errors were corrected using cone-beam computed tomography weekly or more frequently. Treatment toxicities were graded using the Common Terminology Criteria for Adverse Events v4.0. The chemotherapy regimens were 5-fluorouracil-based, combined with oxaliplatin or mitomycin. Five patients received bevacizumab as a part of the chemotherapy regimen.Results: All patients completed neoadjuvant CCRT and received post-CCRT surgical resection. Two had pathological complete response (pCR), and both of these received bevacizumab. Nine of 10 patients had T or N downstaging. Only one patient had pathological nodal involvement. The most common toxicities were grade 1 or 2 anal skin reaction and diarrhea. No patient experienced more than grade 3 toxicity. There was no difference in toxicity between patients with or without bevacizumab. The average displacement in longitudinal, lateral, and vertical directions in the whole group was 0.24 cm, 0.21 cm, and 0.37 cm, respectively. The standard deviation of displacement at longitudinal, lateral, and vertical directions ranged from 0.09-0.34 cm, 0.06-0.20 cm, and 0.11-0.52 cm, respectively.Conclusions: Using VMAT and prone position on a belly board in neoadjuvant CCRT with or without bevacizumab for rectal cancer is feasible and safe. The treatmentrelated toxicity was acceptable and the treatment response was satisfactory. Proneposition technique requires more attention in setup errors.

並列關鍵字

Rectal cancer ； Prone position ； Volumetric modulated arc therapy