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Research ArticleClinical Studies

Treatment Volume, Dose Prescription and Delivery Techniques for Dose-intensification in Rectal Cancer: A National Survey

LUCIANA CARAVATTA, MARCO LUPATTELLI, GIOVANNA MANTELLO, MARIA ANTONIETTA GAMBACORTA, GIUDITTA CHILOIRO, MONICA DI TOMMASO, CONSUELO ROSA, LUCREZIA GASPARINI, ALESSIO GIUSEPPE MORGANTI, VINCENZO PICARDI, RITA MARINA NIESPOLO, MATTIA FALCHETTO OSTI, SABRINA MONTRONE, NICOLA SIMONI, CATERINA BOSO, FRANCESCA FACCHIN, MARIA ASSUNTA DEIDDA, CRISTINA PIVA, CESARE GUIDA, LUIGI ZICCARELLI, FERNANDO MUNOZ, GIOVANNI BATTISTA IVALDI, VANIA MARCHETTI, PAOLA FRANZONE, CORRADO SPATOLA, PIERFRANCESCO FRANCO, VITTORIO DONATO, DOMENICO GENOVESI and on behalf of Gastrointestinal Study Group of AIRO (Italian Association of Radiation Oncology and Clinical Oncology)
Anticancer Research April 2021, 41 (4) 1985-1995; DOI: https://doi.org/10.21873/anticanres.14966
LUCIANA CARAVATTA
1Radiation Oncology Unit, “SS Annunziata” Hospital, “G. D’Annunzio” University, Chieti, Italy;
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  • For correspondence: lcaravatta@hotmail.com
MARCO LUPATTELLI
2Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy;
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GIOVANNA MANTELLO
3Department of Oncology and Radiotherapy, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy;
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MARIA ANTONIETTA GAMBACORTA
4UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS - Rome, Rome, Italy;
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GIUDITTA CHILOIRO
4UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS - Rome, Rome, Italy;
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MONICA DI TOMMASO
1Radiation Oncology Unit, “SS Annunziata” Hospital, “G. D’Annunzio” University, Chieti, Italy;
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CONSUELO ROSA
1Radiation Oncology Unit, “SS Annunziata” Hospital, “G. D’Annunzio” University, Chieti, Italy;
5Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University, Chieti, Italy;
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LUCREZIA GASPARINI
1Radiation Oncology Unit, “SS Annunziata” Hospital, “G. D’Annunzio” University, Chieti, Italy;
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ALESSIO GIUSEPPE MORGANTI
6Radiation Oncology Centre, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy;
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VINCENZO PICARDI
7Radiotherapy Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, Campobasso, Italy;
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RITA MARINA NIESPOLO
8Radiotherapy Unit, Azienda Ospedaliera San Gerardo, Monza, Italy;
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MATTIA FALCHETTO OSTI
9Department of Radiotherapy, “La Sapienza University”, Rome, Italy;
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SABRINA MONTRONE
10Department of Radiotherapy, Pisa University, Pisa, Italy;
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NICOLA SIMONI
11Department of Radiotherapy, Azienda Ospedaliera Universitaria Integrata, Verona, Italy;
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CATERINA BOSO
12Radiotherapy and Nuclear Medicine Unit, IOV-IRCCS, Padua, Italy;
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FRANCESCA FACCHIN
13AULSS 3 Serenissima Ospedale dell’Angelo, Mestre, Italy;
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MARIA ASSUNTA DEIDDA
14Radiotherapy Department, AOB P.O. “A. Businco”, Cagliari, Italy;
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CRISTINA PIVA
15Department of Radiation Oncology, A.S.L. TO4, Ivrea Community Hospital, Ivrea, Italy;
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CESARE GUIDA
16Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy;
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LUIGI ZICCARELLI
17Radiotherapy Unit, Azienda Ospedaliera di Cosenza, Cosenza, Italy;
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FERNANDO MUNOZ
18Radiotherapy Unit, Ospedale Regionale Parini-AUSL Valle d’Aosta, Aosta, Italy;
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GIOVANNI BATTISTA IVALDI
19Radiation Oncology Centre, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy;
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VANIA MARCHETTI
20Radiotherapy Unit, USL Toscana Nord-Ovest, Carrara, Italy;
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PAOLA FRANZONE
21Radiotherapy Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy;
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CORRADO SPATOLA
22UOC Radiodiagnostica e Radioterapia, AOU Policlinico-VE, Catania, Italy;
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PIERFRANCESCO FRANCO
23Department of Oncology, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy;
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VITTORIO DONATO
24Radiation Oncology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
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DOMENICO GENOVESI
1Radiation Oncology Unit, “SS Annunziata” Hospital, “G. D’Annunzio” University, Chieti, Italy;
5Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University, Chieti, Italy;
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Abstract

Background/Aim: The aim of the study was to investigate boost volume definition, doses, and delivery techniques for rectal cancer dose intensification. Patients and Methods: An online survey was made on 25 items (characteristics, simulation, imaging, volumes, doses, planning and treatment). Results: Thirty-eight radiation oncologists joined the study. Twenty-one delivered long-course radiotherapy with dose intensification. Boost volume was delineated on diagnostic magnetic resonance imaging (MRI) in 18 centres (85.7%), and computed tomography (CT) and/or positron emission tomography-CT in 9 (42.8%); 16 centres (76.2%) performed co-registration with CT-simulation. Boost dose was delivered on gross tumor volume in 10 centres (47.6%) and on clinical target volume in 11 (52.4%). The most common total dose was 54-55 Gy (71.4%), with moderate hypofractionation (85.7%). Intensity-modulated radiotherapy (IMRT) was used in all centres, with simultaneous integrated boost in 17 (80.8%) and image-guidance in 18 (85.7%). Conclusion: A high quality of treatment using dose escalation can be inferred by widespread multidisciplinary discussion, MRI-based treatment volume delineation, and radiation delivery relying on IMRT with accurate image-guided radiation therapy protocols.

Key Words:
  • Rectal cancer
  • dose intensification
  • intensity modulated radiotherapy
  • simultaneous integrated boost
  • gross tumor volume
  • Received February 3, 2021.
  • Revision received March 1, 2021.
  • Accepted March 3, 2021.
  • Copyright © 2021 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Treatment Volume, Dose Prescription and Delivery Techniques for Dose-intensification in Rectal Cancer: A National Survey
LUCIANA CARAVATTA, MARCO LUPATTELLI, GIOVANNA MANTELLO, MARIA ANTONIETTA GAMBACORTA, GIUDITTA CHILOIRO, MONICA DI TOMMASO, CONSUELO ROSA, LUCREZIA GASPARINI, ALESSIO GIUSEPPE MORGANTI, VINCENZO PICARDI, RITA MARINA NIESPOLO, MATTIA FALCHETTO OSTI, SABRINA MONTRONE, NICOLA SIMONI, CATERINA BOSO, FRANCESCA FACCHIN, MARIA ASSUNTA DEIDDA, CRISTINA PIVA, CESARE GUIDA, LUIGI ZICCARELLI, FERNANDO MUNOZ, GIOVANNI BATTISTA IVALDI, VANIA MARCHETTI, PAOLA FRANZONE, CORRADO SPATOLA, PIERFRANCESCO FRANCO, VITTORIO DONATO, DOMENICO GENOVESI, on behalf of Gastrointestinal Study Group of AIRO (Italian Association of Radiation Oncology and Clinical Oncology)
Anticancer Research Apr 2021, 41 (4) 1985-1995; DOI: 10.21873/anticanres.14966

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Treatment Volume, Dose Prescription and Delivery Techniques for Dose-intensification in Rectal Cancer: A National Survey
LUCIANA CARAVATTA, MARCO LUPATTELLI, GIOVANNA MANTELLO, MARIA ANTONIETTA GAMBACORTA, GIUDITTA CHILOIRO, MONICA DI TOMMASO, CONSUELO ROSA, LUCREZIA GASPARINI, ALESSIO GIUSEPPE MORGANTI, VINCENZO PICARDI, RITA MARINA NIESPOLO, MATTIA FALCHETTO OSTI, SABRINA MONTRONE, NICOLA SIMONI, CATERINA BOSO, FRANCESCA FACCHIN, MARIA ASSUNTA DEIDDA, CRISTINA PIVA, CESARE GUIDA, LUIGI ZICCARELLI, FERNANDO MUNOZ, GIOVANNI BATTISTA IVALDI, VANIA MARCHETTI, PAOLA FRANZONE, CORRADO SPATOLA, PIERFRANCESCO FRANCO, VITTORIO DONATO, DOMENICO GENOVESI, on behalf of Gastrointestinal Study Group of AIRO (Italian Association of Radiation Oncology and Clinical Oncology)
Anticancer Research Apr 2021, 41 (4) 1985-1995; DOI: 10.21873/anticanres.14966
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Keywords

  • Rectal cancer
  • dose intensification
  • intensity modulated radiotherapy
  • simultaneous integrated boost
  • gross tumor volume
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