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Integrated peripheral boost in preoperative radiotherapy for the locally most advanced non-resectable rectal cancer patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Section of Medical Physics.
Department of Oncology, Oslo University Hospital, Oslo, Norway.
Department of Diagnostic Radiology, Karolinska University Hospital Solna and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm.
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(English)Manuscript (preprint) (Other academic)
National Category
Cancer and Oncology
URN: urn:nbn:se:uu:diva-172407OAI: oai:DiVA.org:uu-172407DiVA: diva2:514574
Available from: 2012-04-10 Created: 2012-04-10 Last updated: 2012-08-01
In thesis
1. Optimising Radiotherapy in Rectal Cancer Patients
Open this publication in new window or tab >>Optimising Radiotherapy in Rectal Cancer Patients
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rectal cancer is the eight most common cancer diagnosis in Sweden in both men and women, with almost 2000 new cases per year. Radiotherapy, which is an important treatment modality for rectal cancer, has evolved during the past decades. Diagnostic tools have also improved, allowing better staging and offering information used to make well-founded decisions in multidisciplinary team conferences.

In a retrospective study (n=46) with locally advanced rectal cancer (LARC) patients, unfit for chemoradiotherapy, patients were treated with short-course radiotherapy. Delayed surgery was done when possible. Radical surgery was possible in 89% of the patients who underwent surgery (80%). Grade IV diarrhoea affected three elderly patients. Target radiation volume should be reduced in elderly or metastatic patients.

In a prospective study (n=68) with LARC patients, magnetic resonance imaging (MRI) and 2-18F-fluoro-2-D-deoxyglucose (FDG) positron emission tomography (PET) were used to determine if FDG-PET could provide extra treatment information. Information from FDG-PET changed the stage of 10 patients. Delineation with FDG-PET generally resulted in smaller target volumes than MRI only.

Seven of the most advanced LARC patients in the above cohort were used for a methodological study to determine if dose escalation to peripheral, non-resectable regions was feasible. Simultaneous integrated boost plans with photons and protons were evaluated. While toxicity was acceptable in five patients with both protons and photons, two patients with very large tumours had unacceptable risk for intestinal toxicity regardless of modality.

In the interim analysis of the Stockholm III Trial (n=303, studying radiotherapy-fractionation and timing of surgery in relation to radiotherapy) compliance was acceptable and severe acute toxicity was infrequent, irrespective of fractionation. Short-course radiotherapy with immediate surgery tended to give more postoperative complications, but only if surgery was delayed more than 10 days after the start of radiotherapy.

Quality-of-life in the Stockholm III Trial was studied before, during and shortly after treatment using the EORTC QLQ-C30 and CR38 questionnaires. Surgery accounted for more adverse effects than radiotherapy in all groups. Postoperatively, the poorest quality-of-life was seen in patients given short-course radiotherapy followed by immediate surgery. No postoperative differences were seen between the two groups with delayed surgery.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 57 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 775
Rectal cancer, locally advanced, radiotherapy, FDG-PET, peripheral boost, protons, quality-of-life
National Category
Cancer and Oncology
Research subject
urn:nbn:se:uu:diva-172531 (URN)978-91-554-8367-8 (ISBN)
Public defence
2012-06-11, Skoogsalen, Akademiska Sjukhuset, ingång 78, Uppsala, 13:15 (Swedish)
Available from: 2012-05-21 Created: 2012-04-11 Last updated: 2012-08-01Bibliographically approved

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