Treatment planning for patients with low rectal cancer in a multicenter prospective organ preservation study

Dennis Tideman Arp; Ane L. Appelt; Lars Henrik Jensen; Birgitte Mayland Havelund; Henrik Dahl Nissen; Signe Lenora Risumlund; Maria Emma Eva Sjölin; Martin Skovmos Nielsen; Laurids Østergaard Poulsen

doi:10.1016/j.ejmp.2023.103206

Treatment planning for patients with low rectal cancer in a multicenter prospective organ preservation study

Dennis Tideman Arp^*, Ane L. Appelt, Lars Henrik Jensen, Birgitte Mayland Havelund, Henrik Dahl Nissen, Signe Lenora Risumlund, Maria Emma Eva Sjölin, Martin Skovmos Nielsen, Laurids Østergaard Poulsen

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

BACKGROUND: Non-surgical management of rectal cancer relies on (chemo)radiotherapy as the definitive treatment modality. This study reports and evaluates the clinical high dose radiotherapy treatment plans delivered to patients with low resectable rectal cancer in a Danish multicenter trial.

METHODS: The Danish prospective multicenter phase II Watchful Waiting 2 trial (NCT02438839) investigated definitive chemoradiation for non-surgical management of low rectal cancer. Three Danish centers participated in the trial and committed to protocol-specified treatment planning and delivery requirements. The protocol specified a dose of 50.4 Gy in 28 fractions to the elective volume (CTV-/PTV-E) and a concomitant boost of 62 Gy in 28 fractions to the primary target volume (CTV-/PTV-T).

RESULTS: The trial included 108 patients, of which 106 treatment plans were available for retrospective analysis. Dose coverage planning goals for the main target structures were fulfilled for 94% of the treatment plans. However, large intercenter differences in doses to organs-at-risk (OARs) were seen, especially for the intestines. Five patients had a V60Gy>10 cm3 for the intestines and two patients for the bladder.

CONCLUSION: Prescribed planning goals for target coverage were fulfilled for 94% of the treatment plans, however analysis of OAR doses and volumes indicated intercenter variations. Dose escalation to 62 Gy (as a concomitant boost to the primary tumor) introduced no substantial high dose volumes (>60 Gy) to the bladder and intestines. The treatment planning goals may be used for future prospective evaluation of highdose radiotherapy for organ preservation for low rectal cancer.

Original language	English
Article number	103206
Journal	Physica Medica
Volume	118
Number of pages	9
ISSN	1120-1797
DOIs	https://doi.org/10.1016/j.ejmp.2023.103206
Publication status	Published - Feb 2024

Bibliographical note

Keywords

Humans
Organ Preservation
Organs at Risk
Prospective Studies
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted/methods
Radiotherapy, Intensity-Modulated/methods
Rectal Neoplasms/radiotherapy
Radiotherapy Treatment Planning
Organ preservation
Rectal cancer
Multicenter

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Arp et al. (2024). Treatment planning for patients with low rectal cancer in a multicenter prospective organ preservation studyFinal published version, 3.48 MBLicence: CC BY 4.0

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title = "Treatment planning for patients with low rectal cancer in a multicenter prospective organ preservation study",

abstract = "BACKGROUND: Non-surgical management of rectal cancer relies on (chemo)radiotherapy as the definitive treatment modality. This study reports and evaluates the clinical high dose radiotherapy treatment plans delivered to patients with low resectable rectal cancer in a Danish multicenter trial.METHODS: The Danish prospective multicenter phase II Watchful Waiting 2 trial (NCT02438839) investigated definitive chemoradiation for non-surgical management of low rectal cancer. Three Danish centers participated in the trial and committed to protocol-specified treatment planning and delivery requirements. The protocol specified a dose of 50.4 Gy in 28 fractions to the elective volume (CTV-/PTV-E) and a concomitant boost of 62 Gy in 28 fractions to the primary target volume (CTV-/PTV-T).RESULTS: The trial included 108 patients, of which 106 treatment plans were available for retrospective analysis. Dose coverage planning goals for the main target structures were fulfilled for 94% of the treatment plans. However, large intercenter differences in doses to organs-at-risk (OARs) were seen, especially for the intestines. Five patients had a V60Gy>10 cm3 for the intestines and two patients for the bladder.CONCLUSION: Prescribed planning goals for target coverage were fulfilled for 94% of the treatment plans, however analysis of OAR doses and volumes indicated intercenter variations. Dose escalation to 62 Gy (as a concomitant boost to the primary tumor) introduced no substantial high dose volumes (>60 Gy) to the bladder and intestines. The treatment planning goals may be used for future prospective evaluation of highdose radiotherapy for organ preservation for low rectal cancer.",

keywords = "Humans, Organ Preservation, Organs at Risk, Prospective Studies, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted/methods, Radiotherapy, Intensity-Modulated/methods, Rectal Neoplasms/radiotherapy, Radiotherapy Treatment Planning, Organ preservation, Rectal cancer, Multicenter",

author = "Arp, {Dennis Tideman} and Appelt, {Ane L.} and Jensen, {Lars Henrik} and Havelund, {Birgitte Mayland} and Nissen, {Henrik Dahl} and Risumlund, {Signe Lenora} and Sj{\"o}lin, {Maria Emma Eva} and Nielsen, {Martin Skovmos} and Poulsen, {Laurids {\O}stergaard}",

year = "2024",

month = feb,

doi = "10.1016/j.ejmp.2023.103206",

language = "English",

volume = "118",

journal = "Physica Medica",

issn = "1120-1797",

publisher = "Pergamon Press",

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T1 - Treatment planning for patients with low rectal cancer in a multicenter prospective organ preservation study

AU - Arp, Dennis Tideman

AU - Appelt, Ane L.

AU - Jensen, Lars Henrik

AU - Havelund, Birgitte Mayland

AU - Nissen, Henrik Dahl

AU - Risumlund, Signe Lenora

AU - Sjölin, Maria Emma Eva

AU - Nielsen, Martin Skovmos

AU - Poulsen, Laurids Østergaard

PY - 2024/2

Y1 - 2024/2

N2 - BACKGROUND: Non-surgical management of rectal cancer relies on (chemo)radiotherapy as the definitive treatment modality. This study reports and evaluates the clinical high dose radiotherapy treatment plans delivered to patients with low resectable rectal cancer in a Danish multicenter trial.METHODS: The Danish prospective multicenter phase II Watchful Waiting 2 trial (NCT02438839) investigated definitive chemoradiation for non-surgical management of low rectal cancer. Three Danish centers participated in the trial and committed to protocol-specified treatment planning and delivery requirements. The protocol specified a dose of 50.4 Gy in 28 fractions to the elective volume (CTV-/PTV-E) and a concomitant boost of 62 Gy in 28 fractions to the primary target volume (CTV-/PTV-T).RESULTS: The trial included 108 patients, of which 106 treatment plans were available for retrospective analysis. Dose coverage planning goals for the main target structures were fulfilled for 94% of the treatment plans. However, large intercenter differences in doses to organs-at-risk (OARs) were seen, especially for the intestines. Five patients had a V60Gy>10 cm3 for the intestines and two patients for the bladder.CONCLUSION: Prescribed planning goals for target coverage were fulfilled for 94% of the treatment plans, however analysis of OAR doses and volumes indicated intercenter variations. Dose escalation to 62 Gy (as a concomitant boost to the primary tumor) introduced no substantial high dose volumes (>60 Gy) to the bladder and intestines. The treatment planning goals may be used for future prospective evaluation of highdose radiotherapy for organ preservation for low rectal cancer.

AB - BACKGROUND: Non-surgical management of rectal cancer relies on (chemo)radiotherapy as the definitive treatment modality. This study reports and evaluates the clinical high dose radiotherapy treatment plans delivered to patients with low resectable rectal cancer in a Danish multicenter trial.METHODS: The Danish prospective multicenter phase II Watchful Waiting 2 trial (NCT02438839) investigated definitive chemoradiation for non-surgical management of low rectal cancer. Three Danish centers participated in the trial and committed to protocol-specified treatment planning and delivery requirements. The protocol specified a dose of 50.4 Gy in 28 fractions to the elective volume (CTV-/PTV-E) and a concomitant boost of 62 Gy in 28 fractions to the primary target volume (CTV-/PTV-T).RESULTS: The trial included 108 patients, of which 106 treatment plans were available for retrospective analysis. Dose coverage planning goals for the main target structures were fulfilled for 94% of the treatment plans. However, large intercenter differences in doses to organs-at-risk (OARs) were seen, especially for the intestines. Five patients had a V60Gy>10 cm3 for the intestines and two patients for the bladder.CONCLUSION: Prescribed planning goals for target coverage were fulfilled for 94% of the treatment plans, however analysis of OAR doses and volumes indicated intercenter variations. Dose escalation to 62 Gy (as a concomitant boost to the primary tumor) introduced no substantial high dose volumes (>60 Gy) to the bladder and intestines. The treatment planning goals may be used for future prospective evaluation of highdose radiotherapy for organ preservation for low rectal cancer.

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KW - Radiotherapy Dosage

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KW - Radiotherapy, Intensity-Modulated/methods

KW - Rectal Neoplasms/radiotherapy

KW - Radiotherapy Treatment Planning

KW - Organ preservation

KW - Rectal cancer

KW - Multicenter

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U2 - 10.1016/j.ejmp.2023.103206

DO - 10.1016/j.ejmp.2023.103206

M3 - Journal article

C2 - 38224663

SN - 1120-1797

VL - 118

JO - Physica Medica

JF - Physica Medica

M1 - 103206

ER -

Treatment planning for patients with low rectal cancer in a multicenter prospective organ preservation study

Abstract

Bibliographical note

Keywords

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