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Neoadjuvant volumetric modulated arc therapy in rectal cancer and the correlation of pathological response with diffusion-weighted MRI and apoptotic markers

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Date

2018

Author

Gurdal, Necla
Emre Merdan Fayda
Alishev, Nijat
Bakir, Baris
Tastekin, Didem
Aykan, Faruk
Gezer, Ugur
Balik, Emre
Saglam, Esra Kaytan
Oral, Ethem Nezih
Gulluoglu, Mine
Kizir, Ahmet

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Citation

Gurdal, N., Fayda, M., Alishev, N., Bakir, B., Tastekin, D., Aykan, F., ... & Gulluoglu, M. (2018). Neoadjuvant volumetric modulated arc therapy in rectal cancer and the correlation of pathological response with diffusion-weighted MRI and apoptotic markers. Tumori Journal, 104(4), 266-272.

Abstract

Purpose: In this prospective observational study, we aimed to report the applicability and tolerability of neoadjuvant volumetric modulated arc therapy with simultaneous integrated boost (SIB-VMAT) and concurrent chemotherapy in patients with locally advanced rectal cancer (LARC), and to evaluate the correlation of pathological response with apparent diffusion coefficient (ADC) measurements on diffusion-weighted magnetic resonance imaging (DW-MRI) and apoptotic markers. Methods: The study enrolled 30 patients with T3 to T4 and/or N+ rectal cancer who preoperatively received SIB-VMAT and concurrent chemotherapy. Before and after the neoadjuvant treatment, apoptotic markers including the nucleosomes and cell-free DNA fragments in the serum samples were examined; DNA integrity was assessed by amplifying the ACTB gene; and the ADC measurements on the DW-MRI were analyzed. Results: No patients had acute or chronic grade III-IV toxicity. Pathologic complete response (pCR) was achieved in 8 patients (27%), while in 10 patients (33%) near-complete pathological response was obtained. Posttreatment ADC was significantly higher in patients with pCR compared with the others (1.28 vs. 1.10, p = 0.017). ROC curve analysis showed that posttreatment ADC values had a sensitivity of 75% and a specificity of 77.3% for distinguishing the patients with pCR from other responders. On the other hand, posttreatment DNA integrity values were revealed lower than the pretreatment values (p = 0.36). Also, the results revealed an insignificant increase in the posttreatment serum level of nucleosomes (p = 0.72). Conclusions: Neoadjuvant SIB-VMAT with concurrent chemotherapy was proved to be a feasible treatment regimen in LARC with tolerable side effects, and improved local control rate and pCR rate.

Source

Tumori J

Volume

104

Issue

4

URI

https://doi.org/10.5301/tj.5000702
https://hdl.handle.net/20.500.12713/756

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  • Makale Koleksiyonu [209]
  • PubMed İndeksli Yayınlar Koleksiyonu [563]
  • Scopus İndeksli Yayınlar Koleksiyonu [709]
  • WoS İndeksli Yayınlar Koleksiyonu [774]



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