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Review
. 2017 Oct;8(5):902-914.
doi: 10.21037/jgo.2017.07.06.

Adaptive radiation dose escalation in rectal adenocarcinoma: a review

Jonathan D Van Wickle  1 , Eric S Paulson  1 , Jerome C Landry  2 , Beth A Erickson  1 , William A Hall  1
Affiliations
Review

Adaptive radiation dose escalation in rectal adenocarcinoma: a review

Jonathan D Van Wickle et al. J Gastrointest Oncol. 2017 Oct.

Abstract

Total mesorectal excision (TME) after neoadjuvant chemoradiotherapy (CRT) has offered superior control for patients with locally advanced rectal cancer, but can carry a quality of life cost. Fortunately, some patients achieve a complete response after CRT alone without the added morbidity caused by surgery. Efforts to increase fidelity of radiation treatment planning and delivery may allow for escalated doses of radiotherapy (RT) with limited off-target toxicity and elicit more pathological complete responses (pCR) to CRT thereby sparing more rectal cancer patients from surgery. In this review, methods of delivering escalated RT boost above 45-50.4 Gy are discussed including: 3D conformal, intensity-modulated radiotherapy (IMRT), and brachytherapy. Newly developed adaptive boost strategies and imaging modalities used in RT planning and response evaluation such as magnetic resonance imaging (MRI) and positron emission tomography (PET) are also discussed.

Keywords: Rectal cancer; adaptive dose escalation; radiotherapy; rectal organ preservation.

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Conflict of interest statement

Conflicts of Interest: Elekta Inc. provides research support to the Medical College of Wisconsin Department of Radiation Oncology. In addition, WA Hall, MD reports research support from the American Cancer Society and the National Institutes of Health.

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