Magnetic resonance linac for locally advanced rectal cancer: a preliminary experience

doi:10.3877/cma.j.issn.2095-3224.2023.06.014

Abstract

Abstract:

As an emerging radiation therapy modality, experience with magnetic resonance linac (MR-Linac) for rectal cancer is rarely reported. This article introduces a procedure for the treatment of rectal cancer with MR-Linac and reports the preliminary results of the treatment of 6 cases of locally advanced rectal cancer using this procedure. All of the rectal tumors regressed, with 2 cases (2/6) achieving complete tumor regression, and no≥G3 acute toxicities occurred during radiation therapy. Before the implementation of each radiotherapy, MR image shows the anatomy and target volume clearly, which can successfully realize online adaptive radiotherapy and real-time tracking radiotherapy. MR-linac has a good prospect in the radiotherapy of rectal cancer.

Key words: Rectal neoplasms, Radiotherapy, Magnetic resonance linac

Huiying Ma, Xinling Fan, Shirui Tan, Jiayun Chen, Ying Cao, Yuan Xu, Jing Jin, Yuan Tang. Magnetic resonance linac for locally advanced rectal cancer: a preliminary experience[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(06): 519-523.

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URL: https://zhjzcjbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3224.2023.06.014

https://zhjzcjbdzzz.cma-cmc.com.cn/EN/Y2023/V12/I06/519

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References 24

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病例	年龄	性别	分期（AJCC 8^th）	MRF	EMVI	肿瘤下缘距肛门距离（cm）
1	68	女	T3aN2M0 IIIB期	阳性	0级	<5
2	55	男	T3bN1bM0 IIIB期	阴性	3级	<5
3	53	男	T3bN1bM0 IIIB期	阳性	4级	<5
4	63	女	T4aN2bM0 IIIC期	阳性	3级	≥5
5	68	女	T3cN2bM0 IIIC期	阴性	3级	≥5
6	44	男	T4bN1bM0 IIIC期	阳性	2级	<5

病例	年龄	性别	分期（AJCC 8^th）	MRF	EMVI	肿瘤下缘距肛门距离（cm）
1	68	女	T3aN2M0 IIIB期	阳性	0级	<5
2	55	男	T3bN1bM0 IIIB期	阴性	3级	<5
3	53	男	T3bN1bM0 IIIB期	阳性	4级	<5
4	63	女	T4aN2bM0 IIIC期	阳性	3级	≥5
5	68	女	T3cN2bM0 IIIC期	阴性	3级	≥5
6	44	男	T4bN1bM0 IIIC期	阳性	2级	<5

病例	放疗方案	新辅助化疗方案	新辅助治疗期间毒副反应^b	新辅助治疗后疗效评估	新辅助治疗后治疗选择	切除类型	病理T分期	病理N分期	TRG分级^d
1	PTV 25Gy/5f序贯PGTV 4Gy/1f	4周期XELOX^a	Ⅱ度放射性肠炎，Ⅱ度骨髓抑制	CR	等待观察	/	/	/	/
2	PTV 25Gy/5f	6周期XELOX	Ⅱ度放射性肠炎，Ⅰ度放射性皮炎	CR	根治性手术（Dixon术^c）	R0	T0	N0	4级
3	PTV 25Gy/5f序贯PGTV 4Gy/1f	6周期XELOX	Ⅰ度放射性肠炎	PR	根治性手术（Dixon术）	R0	T3	N0	2级
4	PTV 25Gy/5f序贯PGTV 4Gy/1f	2周期XELOX	Ⅱ度放射性肠炎，Ⅰ度骨髓抑制	PR	根治性手术（Dixon术）	R0	T2	N0	3级
5	PTV 25Gy/5f	2周期XELOX	Ⅱ度放射性肠炎	SD	根治性手术（Dixon术）	R0	T4a	N1	1级
6	PTV 25Gy/5f序贯PGTV 4Gy/1f	4周期XELOX	Ⅰ度放射性肠炎	PR	根治性手术（Dixon术）	R0	T2	N0	2级

病例	放疗方案	新辅助化疗方案	新辅助治疗期间毒副反应^b	新辅助治疗后疗效评估	新辅助治疗后治疗选择	切除类型	病理T分期	病理N分期	TRG分级^d
1	PTV 25Gy/5f序贯PGTV 4Gy/1f	4周期XELOX^a	Ⅱ度放射性肠炎，Ⅱ度骨髓抑制	CR	等待观察	/	/	/	/
2	PTV 25Gy/5f	6周期XELOX	Ⅱ度放射性肠炎，Ⅰ度放射性皮炎	CR	根治性手术（Dixon术^c）	R0	T0	N0	4级
3	PTV 25Gy/5f序贯PGTV 4Gy/1f	6周期XELOX	Ⅰ度放射性肠炎	PR	根治性手术（Dixon术）	R0	T3	N0	2级
4	PTV 25Gy/5f序贯PGTV 4Gy/1f	2周期XELOX	Ⅱ度放射性肠炎，Ⅰ度骨髓抑制	PR	根治性手术（Dixon术）	R0	T2	N0	3级
5	PTV 25Gy/5f	2周期XELOX	Ⅱ度放射性肠炎	SD	根治性手术（Dixon术）	R0	T4a	N1	1级
6	PTV 25Gy/5f序贯PGTV 4Gy/1f	4周期XELOX	Ⅰ度放射性肠炎	PR	根治性手术（Dixon术）	R0	T2	N0	2级

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