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. 2020 Feb 4:21:104-111.
doi: 10.1016/j.ctro.2020.02.001. eCollection 2020 Mar.

Mesorectal radiotherapy for early stage rectal cancer: A novel target volume

Femke P Peters  1 , Mark T W Teo  2 , Ane L Appelt  3 , Simon Bach  4 , Gunnar Baatrup  5 , Johannes H W de Wilt  6 , Camilla Jensenius Kronborg  7 , Karen-Lise Garm Spindler  7 , Corrie A M Marijnen  1 , David Sebag-Montefiore  3
Affiliations

Mesorectal radiotherapy for early stage rectal cancer: A novel target volume

Femke P Peters et al. Clin Transl Radiat Oncol. .

Abstract

With the introduction of population-based bowel cancer screening, rectal cancer is diagnosed at earlier stages, yet standard treatment still requires the same extensive surgery that is used for more advanced stages. Organ preserving treatment is rapidly developing and is subject of investigation in numerous clinical trials. The STAR-TREC trial is an international, multi-centre randomised trial investigating organ preservation using (chemo)radiotherapy. Patients with small mrT1-3bN0V0M0 tumours are randomized between three arms: standard TME, organ preservation with SCRT or with CRT. In this trial, the clinical target volume has been tailored to the early staged disease of the included patients. This mesorectal irradiation volume includes the mesorectum and pre-sacral lymph nodes at the level of the tumour, two centimetres below and cranially up to the S2-3 interspace level. In contrast to conventional irradiation volumes, the lateral lymph nodes and the nodes along the superior rectal artery are excluded. As a result, the dose to the bowel, bladder, anal sphincter and the neurovascular plexus in the lower pelvis is substantially decreased, especially when combined with modern irradiation techniques, such as dynamic arc therapy. These lower doses are expected to lead to decreasing acute and late toxicity and beneficial functional outcomes. The implementation of this novel target volume will be accompanied by an extensive quality assurance program in the STAR-TREC trial. We describe the rationale behind the novel, mesorectal only radiotherapy treatment used in the STAR-TREC trial specifically tailored for early stage disease, with the goal of organ preservation.

Keywords: Clinical target volumes; OP, organ preservation; Organ Preservation; RO, radiation oncologist; Radiotherapy; Rectal neoplasms; WG, working group.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig 1
(a and b) Superior limit mesorectal target volume.
Fig 2
Fig 2
(a and b) Inferior limit mesorectal target volume.
Fig 3
Fig 3
(a–c) Anterior limit mesorectal target volume.
Fig 4
Fig 4
(a–c) Posterior limit mesorectal target volume.
Fig 5
Fig 5
(a–d) Lateral limit mesorectal target volume.
See this image and copyright information in PMC

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