Treatment Volume, Dose Prescription and Delivery Techniques for Dose-intensification in Rectal Cancer: A National Survey

Anticancer Res. 2021 Apr;41(4):1985-1995. doi: 10.21873/anticanres.14966.


Background/aim: The aim of the study was to investigate boost volume definition, doses, and delivery techniques for rectal cancer dose intensification.

Patients and methods: An online survey was made on 25 items (characteristics, simulation, imaging, volumes, doses, planning and treatment).

Results: Thirty-eight radiation oncologists joined the study. Twenty-one delivered long-course radiotherapy with dose intensification. Boost volume was delineated on diagnostic magnetic resonance imaging (MRI) in 18 centres (85.7%), and computed tomography (CT) and/or positron emission tomography-CT in 9 (42.8%); 16 centres (76.2%) performed co-registration with CT-simulation. Boost dose was delivered on gross tumor volume in 10 centres (47.6%) and on clinical target volume in 11 (52.4%). The most common total dose was 54-55 Gy (71.4%), with moderate hypofractionation (85.7%). Intensity-modulated radiotherapy (IMRT) was used in all centres, with simultaneous integrated boost in 17 (80.8%) and image-guidance in 18 (85.7%).

Conclusion: A high quality of treatment using dose escalation can be inferred by widespread multidisciplinary discussion, MRI-based treatment volume delineation, and radiation delivery relying on IMRT with accurate image-guided radiation therapy protocols.

Keywords: Rectal cancer; dose intensification; gross tumor volume; intensity modulated radiotherapy; simultaneous integrated boost.

MeSH terms

  • Female
  • Humans
  • Italy / epidemiology
  • Lymphatic Metastasis
  • Magnetic Resonance Imaging
  • Male
  • Neoplasm Staging
  • Positron Emission Tomography Computed Tomography
  • Positron-Emission Tomography
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted* / adverse effects
  • Radiotherapy Planning, Computer-Assisted* / methods
  • Radiotherapy Planning, Computer-Assisted* / statistics & numerical data
  • Radiotherapy, Image-Guided / adverse effects
  • Radiotherapy, Image-Guided / methods
  • Radiotherapy, Image-Guided / statistics & numerical data
  • Radiotherapy, Intensity-Modulated* / adverse effects
  • Radiotherapy, Intensity-Modulated* / methods
  • Radiotherapy, Intensity-Modulated* / statistics & numerical data
  • Rectal Neoplasms / diagnosis
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / radiotherapy*
  • Surveys and Questionnaires
  • Survival Analysis
  • Tumor Burden / physiology*
  • Tumor Burden / radiation effects