A Retrospective Comparison of Toxicity, Response and Survival of Intensity-Modulated Radiotherapy Versus Three-Dimensional Conformal Radiation Therapy in the Treatment of Rectal Carcinoma.

INTRODUCTION: The main target of neoadjuvant treatment in rectal cancer is to downstage and downsize large tumours to increase the chance of complete surgical resection, and therefore decrease the chances of local recurrence. With or without the addition of chemotherapy, until recently, three-dimensional conformal radiotherapy (3D-CRT) used to be the radiotherapy treatment modality of choice. However, intensity-modulated radiotherapy (IMRT) is being increasingly adopted by many radiotherapy centres as a more modern, conformal technique due to its ability to minimize radiation dose to nearby organs. The aim of our analysis was to assess the difference in toxicity, response to treatment, and survival between the patients treated with these two different treatment modalities in our institution. METHODS: We performed a retrospective analysis of data and compared two groups of patients with locally advanced rectal cancer who were treated with either 3D-CRT or IMRT. The main outcomes were radiation toxicity and response to treatment. Overall survival was a secondary outcome. RESULTS: One hundred and thirty-six patients were included in the study: 71 patients treated with 3D-CRT and 65 patients treated with IMRT. With regard to toxicity, there was no significant difference between the groups for bladder and skin toxicity, but there was a significant reduction in acute grade 2 bowel toxicity in patients treated with a long course of IMRT [3D-CRT 77% (48/62) vs IMRT 64% (30/47) p=0.042]. There was no statistically significant difference in the treatment response rates of these two radiotherapy treatment modalities, as well as in overall survival between the groups (p=0.604).  Conclusion: Our study showed that IMRT can significantly reduce acute bowel side effects for patients undergoing neoadjuvant radiotherapy for locally advanced rectal cancers. Further studies are needed to confirm the clinical advantage of IMRT in rectal carcinoma.

The Accuracy of Digital Preoperative Templating in Primary Total Hip Replacements.

Background​ Digital templating is an essential part of preoperative planning in elective total hip replacement (THR) surgery. The goals of templating are to predict femoral and acetabular implant sizes, to assess leg length, offset, and implant positioning. Templating markers such as the KingMark device (Brainlab, Munich, Germany) have been developed to improve the accuracy. Although templating is commonly used in many centres, there are challenges related to the accuracy of the process, such as true magnification ideal positioning of the pelvis and hips/body habit (obesity). Objectives The aim of this study was to assess the accuracy of preoperative templating in THR patients, and to assess the difference between templating performed with and without the KingMark device. Methods​ Our retrospective study included 642 consecutive patients who had primary THR at the Royal Bournemouth Hospital in the UK. Four hundred fifty-three (71%) of patients had the KingMark device on their templated radiographs. Patients who had hybrid total hip replacements using an uncemented acetabular component and cemented femoral component were included in the study. Digital templating was done using TraumaCad software (Brainlab). Analysis of the accuracy of predicting component size has been evaluated by comparing preoperative planned sizes with implanted sizes as documented by the surgeons and labels attached to the operative note. ​ ​Results​ The templated size corresponded to the actual femoral implant used in approximately 65.2% of cases. When femoral prostheses within one size above or below the templated size were included,​the accuracy of preoperative templating rose to 97.2%. Regarding the uncemented acetabular component, the templated size corresponded to the actual acetabular implant used in 46.3% of cases. When acetabular cup within one size above or below the templated size were included, the accuracy of preoperative templating rose to 87.5%. Similarly, there was minimal difference between the predicted templated sizes using the KingMark device compared to templating performed without it. ​Conclusions​ Preoperative templating is an essential part in optimizing the outcome of THRs. Templating allows the surgeon to estimate the size of the components to be used. It also provides a starting point, from which the surgeon can proceed from, and saves valuable intraoperative time by assessing the level of the femoral neck osteotomy and the degree of lateral rasping. Multiple factors affect the accuracy of preoperative templating including the patient BMI, external rotation of the hip and surgeon's experience. Although there are different methods of templating, digital templating with 2D radiographs is likely the most cost-effective and efficient process available at this time.