title: Patterns of practice in the radiation therapy management of rectal cancer: survey of the Interregional Group Piedmont, Valle d'Aosta and Liguria of the "Associazione Italiana di Radioterapia Oncologica (AIRO)".
abstract: OBJECTIVE
  To report the survey about the main aspects on the use of radiotherapy for the treatment of rectal cancer in Piedmont and Liguria.
  
  
  METHODS
  Sixteen centers (11 from Piedmont and 5 from Liguria) received and answered by email a questionnaire data base about clinical and technical aspects of the treatment of rectal cancer. All data were incorporated in a single data base and analyzed.
  
  
  RESULTS
  Data regarding 593 patients who received radiotherapy for rectal cancer during the year 2009 were collected and analyzed. Staging consisted in colonoscopy, thoracic and abdominal CT, pelvic MRI and endoscopic ultrasound. PET/CT was employed to complete staging and in the treatment planning in 12/16 centers (75%). Neoadjuvant radiotherapy was employed more frequently than adjuvant radiotherapy (50% vs 36.4%), using typically a total dose of 45 Gy with 1.8 Gy/fraction. Concurrent chemoradiation with 5-fluorouracil or capecitabine was mainly employed in neoadjuvant and adjuvant settings, whereas oxaliplatin alone or in combination with 5-FU or capecitabine and leucovorin was commonly employed as the adjuvant agent. The median interval from neoadjuvant treatment to surgery was 7 weeks after long-course radiotherapy and 8 days after short-course radiotherapy. The pelvic total dose of 45 Gy in the adjuvant setting was the same in all the centers. Doses higher than 45 Gy were employed with a radical intent or in case of positive surgical margins. Hypofractionated regimens (2.5, 3 Gy to a total dose of 35-30 Gy) were used in the palliative setting. No relevant differences were observed in target volume definition and patient setup. Twenty-six patients (4.4%) developed grade 3 acute toxicity. Follow-up was scheduled in a similar way in all the centers.
  
  
  CONCLUSIONS
  No relevant differences were found among the centers involved in the survey. The approach can help clinicians to address important clinical questions and to improve consistency and homogeneity of treatments.
authors.affiliation: Radiotherapy, University Hospital Maggiore della Carità, Novara, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Di Genesio Pagliuca
authors.forename: Lucia
authors.initials: L
authors.lastname: Turri
authors.forename: Fernando
authors.initials: F
authors.lastname: Munoz
authors.forename: Antonella
authors.initials: A
authors.lastname: Melano
authors.forename: Almalina
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Paola
authors.initials: P
authors.lastname: Franzone
authors.forename: Piera
authors.initials: P
authors.lastname: Sciacero
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Tseroni
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Vitali
authors.forename: Elena
authors.initials: E
authors.lastname: Delmastro
authors.forename: Tindaro
authors.initials: T
authors.lastname: Scolaro
authors.forename: Corrado
authors.initials: C
authors.lastname: Marziano
authors.forename: Marco
authors.initials: M
authors.lastname: Orsatti
authors.forename: Maria
authors.initials: M
authors.lastname: Tessa
authors.forename: Annalisa
authors.initials: A
authors.lastname: Rossi
authors.forename: Andrea
authors.initials: A
authors.lastname: Ballare
authors.forename: Gregorio
authors.initials: G
authors.lastname: Moro
authors.forename: Rachele
authors.initials: R
authors.lastname: Grasso
authors.forename: Marco
authors.initials: M
authors.lastname: Krengli
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D003113:Colonoscopy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D019160:Endosonography; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D019538:Health Care Surveys; D006801:Humans; D007558:Italy; D002955:Leucovorin / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010166:Palliative Care / Q000379:methods; D010348:Patient Care Team; D049268:Positron-Emission Tomography; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D018787:Radiation Oncology / Q000379:methods / Q000706:statistics & numerical data*; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D012955:Societies, Medical; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D002955:Leucovorin; D005472:Fluorouracil