방사선의학 웹진

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Abstract
Background:
To compare the acute gastrointestinal (GI) and genitourinary (GU) toxicity profiles between intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT) in rectal cancer patients treated with neoadjuvant chemoradiation (NCRT) using meta-analysis and pooled-analysis from published articles.

Methods:
Literature search was performed in PubMed and EMBASE from inception to March 2017. The odd ratios (ORs) were calculated and random effects model was used for meta-analysis. Chi-square or Fisher's exact test was performed for the pooled-analysis.

Results:
Six studies including a total of 859 patients met the inclusion criteria. Most patients (98.7%) received NCRT. In the meta-analysis, IMRT reduced grade ≥ 2 acute overall GI toxicity, diarrhea and proctitis with ORs of 0.38, 0.32 and 0.60, respectively (all P < 0.05), compared to 3DCRT. IMRT also reduced acute grade ≥ 3 proctitis compared to 3D-CRT (OR, 0.24; P = 0.03). No significant heterogeneity or publication bias was detected. In the pooled-analysis, IMRT reduced the incidence of grade ≥ 2 acute overall GI toxicity, diarrhea, proctitis and GU toxicity (all P < 0.05). Moreover, lower incidence of grade ≥ 3 acute overall GI toxicity, diarrhea and proctitis were observed in the patients treated with IMRT (all P < 0.05).

Conclusions:
IMRT significantly reduced acute toxicity in locally advanced rectal cancer patients treated with NCRT compared to 3DCRT.

Author information

Wee CW1, Kang HC1, Wu HG1,2,3, Chie EK1,2,3, Choi N1, Park JM1,3, Kim JI1,3, Huang CM4, Wang JY5, Ng SY6, Goodman KA7,8.
1
Department of Radiation Oncology, Seoul National University College of Medicine.
2
Cancer Research Institution, Seoul National University College of Medicine.
3
Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
4
Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University.
5
Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
6
Alfred Health Radiation Oncology, Victoria, Australia.
7
Department of Radiation Oncology, University of Colorado Denver School of Medicine, Aurora.
8
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.