Locoregional relapses in the ACCORD 12/0405-PRODIGE 02 study: Dosimetric study and risk factors

•Most relapses in after radiation therapy for locally advanced rectal adenocarcinoma happen in the treated volume or close by.•Locations of relapses are coherent with published guideline such as by Valentini et al.•Caution should be taken for T4 tumors and possibly lower rectum tumors as they are mo...

Full description

Saved in:
Bibliographic Details
Published in:Radiotherapy and oncology 2021-08, Vol.161, p.198-204
Main Authors: Meillan, Nicolas, Orthuon, Alexandre, Chauchat, Paul, Atlani, David, Bouche, Olivier, Chaulin, Bertrand, David, Céline, Deberne, Mélanie, Debrigode, Charles, Kao, William, Keller, Audrey, Laharie, Hortense, Lamezec, Bruno, Lemanski, Claire, Magné, Nicolas, Mahé, Marc-André, Mere, Pascale, Moureau-Zabotto, Laurence, Peiffert, Didier, Pointreau, Yoann, Quéro, Laurent, Racadot, Séverine, Roca, Sophie, Sargos, Paul, Servagi, Stéphanie, Tang, Eliane, Vendrely, Véronique, Doyen, Jérôme, Huguet, Florence
Format: Article
Language:English
Subjects:
Dosimetry
Local relapse
Neoadjuvant
Radiation therapy
Rectal adenocarcinoma
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:•Most relapses in after radiation therapy for locally advanced rectal adenocarcinoma happen in the treated volume or close by.•Locations of relapses are coherent with published guideline such as by Valentini et al.•Caution should be taken for T4 tumors and possibly lower rectum tumors as they are more likely to relapse outside of the treated volume. The aim of this study is to correlate locoregional relapse with radiation therapy volumes in patients with rectal cancer treated with neoadjuvant chemoradiation in the ACCORD 12/0405-PRODIGE 02 trial. We identified patients who had a locoregional relapse included in ACCORD 12's database. We studied their clinical, radiological, and dosimetric data to analyze the dose received by the area of relapse. 39 patients (6.5%) presented 54 locoregional relapses. Most of the relapses were in-field (n = 21, 39%) or marginal (n = 13, 24%) with only six out-of-field (11%), 14 could not be evaluated. Most of them happened in the anastomosis, the perirectal space, and the usual lymphatic drainage areas (presacral and posterior lateral lymph nodes). Only patients treated for a lower rectum adenocarcinoma had a relapse outside of the treated volume. 2 patients with T4 tumors extending into anterior pelvic organs had relapses in anterior lateral and external iliac lymph nodes. Lowering the upper limit of the treatment field for low rectal tumors increased the risk of out of the field recurrence. For very low tumors, including the inguinal lymph nodes in the treated volume should be considered. Recording locoregional involvement, treated volumes, and relapse areas in future prospective trials would be of paramount interest to refine delineation guidelines.
ISSN:0167-8140
1879-0887
DOI:10.1016/j.radonc.2021.06.006