Max D Tanaka, Bengt Glimelius, Geke A P Hospers, Elma Meershoek-Klein Kranenbarg, Corrie A M Marijnen, Hein Putter, Annet G H Roodvoets, Cornelis J H van de Velde, Boudewijn van Etten, Per J Nilsson, Alice M Couwenberg
{"title":"在RAPIDO试验中，与3D-CRT相比，IMRT治疗局部晚期直肠癌后的急性和晚期放射相关毒性","authors":"Max D Tanaka, Bengt Glimelius, Geke A P Hospers, Elma Meershoek-Klein Kranenbarg, Corrie A M Marijnen, Hein Putter, Annet G H Roodvoets, Cornelis J H van de Velde, Boudewijn van Etten, Per J Nilsson, Alice M Couwenberg","doi":"10.1016/j.ijrobp.2025.04.035","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Intensity-modulated radiotherapy (IMRT) aims to lower radiation-related toxicity by delivering more conformal radiotherapy compared to three-dimensional conformal radiotherapy (3D-CRT). This study investigated whether IMRT (including volumetric modulated arc therapy) resulted in less acute and late radiation-related toxicity and better treatment compliance compared to 3D-CRT in the phase III RAPIDO trial.</p><p><strong>Methods and materials: </strong>Patients with locally advanced rectal cancer (LARC), treated with short-course radiotherapy followed by consolidation therapy (TNT arm) or chemoradiotherapy with optional postoperative chemotherapy (CRT arm) were included. IMRT was compared to 3D-CRT, stratified by treatment arm. Acute, late, and persistent toxicity endpoints included radiation-related gastrointestinal, general, genitourinary, hematological, and sexual adverse events (CTCAEv4). Toxicity endpoints were analyzed as binary outcomes (grade ≥ 1 vs. grade 0 and grade ≥ 3 vs. grade 0-2) with univariable and multivariable logistic regression analyses.</p><p><strong>Results: </strong>For acute and late toxicity analyses, 460 and 352 patients were eligible in the TNT arm, respectively, and 441 and 321 patients in the CRT arm. IMRT was delivered in 29% of the patients. After IMRT in the TNT arm, more acute fatigue grade ≥ 1 (OR 2.71 [95%CI 1.60-4.60], p<0.001) and more acute nausea/vomiting grade ≥ 1 (OR 1.79 [95%CI 1.15-2.79], p=0.010) was observed compared to 3D-CRT. After IMRT in the CRT arm, more any late radiation-related toxicity grade ≥ 1 (OR 2.14 [95%CI 1.28-3.57], p=0.004) and more late sexual toxicity grade ≥ 1 (OR 2.31 [95%CI 1.24-4.29], p=0.008) was observed compared to 3D-CRT. No differences were found for other grade ≥ 1 toxicity endpoints, grade ≥ 3 toxicity, or treatment compliance. Persistent toxicity was rare in both groups.</p><p><strong>Conclusions: </strong>IMRT was not associated with less radiation-related toxicity compared to 3D-CRT after TNT or CRT. In contrast, some lower grade toxicities were more frequent after IMRT, in particular fatigue during TNT. Late persistent toxicity was uncommon in both groups.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4000,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Acute and late radiation-related toxicity after treatment of locally advanced rectal cancer with IMRT compared to 3D-CRT in the RAPIDO trial.\",\"authors\":\"Max D Tanaka, Bengt Glimelius, Geke A P Hospers, Elma Meershoek-Klein Kranenbarg, Corrie A M Marijnen, Hein Putter, Annet G H Roodvoets, Cornelis J H van de Velde, Boudewijn van Etten, Per J Nilsson, Alice M Couwenberg\",\"doi\":\"10.1016/j.ijrobp.2025.04.035\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Intensity-modulated radiotherapy (IMRT) aims to lower radiation-related toxicity by delivering more conformal radiotherapy compared to three-dimensional conformal radiotherapy (3D-CRT). This study investigated whether IMRT (including volumetric modulated arc therapy) resulted in less acute and late radiation-related toxicity and better treatment compliance compared to 3D-CRT in the phase III RAPIDO trial.</p><p><strong>Methods and materials: </strong>Patients with locally advanced rectal cancer (LARC), treated with short-course radiotherapy followed by consolidation therapy (TNT arm) or chemoradiotherapy with optional postoperative chemotherapy (CRT arm) were included. IMRT was compared to 3D-CRT, stratified by treatment arm. Acute, late, and persistent toxicity endpoints included radiation-related gastrointestinal, general, genitourinary, hematological, and sexual adverse events (CTCAEv4). Toxicity endpoints were analyzed as binary outcomes (grade ≥ 1 vs. grade 0 and grade ≥ 3 vs. grade 0-2) with univariable and multivariable logistic regression analyses.</p><p><strong>Results: </strong>For acute and late toxicity analyses, 460 and 352 patients were eligible in the TNT arm, respectively, and 441 and 321 patients in the CRT arm. IMRT was delivered in 29% of the patients. After IMRT in the TNT arm, more acute fatigue grade ≥ 1 (OR 2.71 [95%CI 1.60-4.60], p<0.001) and more acute nausea/vomiting grade ≥ 1 (OR 1.79 [95%CI 1.15-2.79], p=0.010) was observed compared to 3D-CRT. After IMRT in the CRT arm, more any late radiation-related toxicity grade ≥ 1 (OR 2.14 [95%CI 1.28-3.57], p=0.004) and more late sexual toxicity grade ≥ 1 (OR 2.31 [95%CI 1.24-4.29], p=0.008) was observed compared to 3D-CRT. No differences were found for other grade ≥ 1 toxicity endpoints, grade ≥ 3 toxicity, or treatment compliance. Persistent toxicity was rare in both groups.</p><p><strong>Conclusions: </strong>IMRT was not associated with less radiation-related toxicity compared to 3D-CRT after TNT or CRT. In contrast, some lower grade toxicities were more frequent after IMRT, in particular fatigue during TNT. Late persistent toxicity was uncommon in both groups.</p>\",\"PeriodicalId\":14215,\"journal\":{\"name\":\"International Journal of Radiation Oncology Biology Physics\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.4000,\"publicationDate\":\"2025-05-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Radiation Oncology Biology Physics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ijrobp.2025.04.035\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Radiation Oncology Biology Physics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ijrobp.2025.04.035","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Acute and late radiation-related toxicity after treatment of locally advanced rectal cancer with IMRT compared to 3D-CRT in the RAPIDO trial.
Purpose: Intensity-modulated radiotherapy (IMRT) aims to lower radiation-related toxicity by delivering more conformal radiotherapy compared to three-dimensional conformal radiotherapy (3D-CRT). This study investigated whether IMRT (including volumetric modulated arc therapy) resulted in less acute and late radiation-related toxicity and better treatment compliance compared to 3D-CRT in the phase III RAPIDO trial.
Methods and materials: Patients with locally advanced rectal cancer (LARC), treated with short-course radiotherapy followed by consolidation therapy (TNT arm) or chemoradiotherapy with optional postoperative chemotherapy (CRT arm) were included. IMRT was compared to 3D-CRT, stratified by treatment arm. Acute, late, and persistent toxicity endpoints included radiation-related gastrointestinal, general, genitourinary, hematological, and sexual adverse events (CTCAEv4). Toxicity endpoints were analyzed as binary outcomes (grade ≥ 1 vs. grade 0 and grade ≥ 3 vs. grade 0-2) with univariable and multivariable logistic regression analyses.
Results: For acute and late toxicity analyses, 460 and 352 patients were eligible in the TNT arm, respectively, and 441 and 321 patients in the CRT arm. IMRT was delivered in 29% of the patients. After IMRT in the TNT arm, more acute fatigue grade ≥ 1 (OR 2.71 [95%CI 1.60-4.60], p<0.001) and more acute nausea/vomiting grade ≥ 1 (OR 1.79 [95%CI 1.15-2.79], p=0.010) was observed compared to 3D-CRT. After IMRT in the CRT arm, more any late radiation-related toxicity grade ≥ 1 (OR 2.14 [95%CI 1.28-3.57], p=0.004) and more late sexual toxicity grade ≥ 1 (OR 2.31 [95%CI 1.24-4.29], p=0.008) was observed compared to 3D-CRT. No differences were found for other grade ≥ 1 toxicity endpoints, grade ≥ 3 toxicity, or treatment compliance. Persistent toxicity was rare in both groups.
Conclusions: IMRT was not associated with less radiation-related toxicity compared to 3D-CRT after TNT or CRT. In contrast, some lower grade toxicities were more frequent after IMRT, in particular fatigue during TNT. Late persistent toxicity was uncommon in both groups.
期刊介绍：
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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