Impact of Dose-Escalated Chemoradiation on Quality of Life in Patients With Locally Advanced Rectal Cancer: 2-Year Follow-Up of the Randomized RECTAL-BOOST Trial.

PURPOSE: Dose-escalated chemoradiation (CRT) for locally advanced rectal cancer did not result in higher complete response rates but initiated more tumor regression in the randomized RECTAL-BOOST trial (Clinicaltrials.gov NCT01951521). This study compared patient reported outcomes between patients who received dose-escalated CRT (5 × 3 gray boost + CRT) or standard CRT for 2 years after randomization. METHODS AND MATERIALS: Patients with locally advanced rectal cancer who were participating in the RECTAL-BOOST trial filled out European Organisation for Research and Treatment of Cancer QLQ-C30 and CR29 questionnaires on quality of life (QoL) and symptoms at baseline, 3, 6, 12, 18, and 24 months after start of treatment. Between-group differences in functional QoL domains were estimated using a linear mixed-effects model and expressed as effect size (ES). Symptom scores were compared using Mann-Whitney U test. RESULTS: Patients treated with dose-escalated CRT (boost group, n = 51) experienced a significantly stronger decline in global health at 3 and 6 months (ES -0.4 and ES -0.4), physical functioning at 6 months (ES -1.1), role functioning at 3 and 6 months (ES -0.8 and ES -0.6), and social functioning at 6 months (ES -0.6), compared with patients treated with standard CRT (control group, n = 64). The boost group reported significantly more fatigue at 3 and 6 months (83% vs 66% respectively 89% vs 76%), pain at 3 and 6 months (67% vs 36% respectively 80% vs 44%), and diarrhea at 3 months (45% vs 29%) compared with the control group. From 12 months onwards, QoL and symptoms were similar between groups, apart from more blood/mucus in stool in the boost group. CONCLUSIONS: In patients with locally advanced rectal cancer, dose-escalated CRT resulted in a transient deterioration in global health, physical, role, and social functioning and more pain, fatigue and diarrhea at 3 and 6 months after start of treatment compared with standard CRT. From 12 months onwards, the effect of dose-escalated CRT on QoL largely resolved.

[MRI-guided radiotherapy: An innovation for patients with upper abdominal malignancies]. / Radiotherapie op geleide van het actuele MRI-beeld.

MRI-guided radiotherapy is a new technique for high-precision radiation(stereotactic radiotherapy) for patients with malignancies. This minimally invasive treatmentis carried out with the aid of an irradiation device with an integrated MRI scanner, the 'magnetic resonance linear accelerator' (MR-Linac), which is used to image the tumour and surrounding tissue immediately before each radiotherapy treatment. The radiation plan can be adapted on the basis of the latest MRI image as required. MRI-guided radiotherapy can have advantages when treating patients with malignancies in the upper abdomen, such as pancreatic carcinoma or periampullary malignancies. These tumours and the surrounding tissues are often poorly visible on the CT scans used in conventional radiotherapy techniques. Patients with upper-abdominal malignancies can be precisely and effectively treated with MRI-guided radiotherapy and organs that are sensitive to radiation can be spared as much as possible, thus decreasing the risk of side-effects.