Case Report
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World J Gastroenterol. Dec 28, 2014; 20(48): 18480-18486
Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18480
Modified simultaneous integrated boost radiotherapy for an unresectable huge refractory pelvic tumor diagnosed as a rectal adenocarcinoma
Takuma Nomiya, Hiroko Akamatsu, Mayumi Harada, Ibuki Ota, Yasuhito Hagiwara, Mayumi Ichikawa, Misako Miwa, Shouhei Kawashiro, Motohisa Hagiwara, Masahiro Chin, Eiji Hashizume, Kenji Nemoto
Takuma Nomiya, Mayumi Harada, Department of Radiation Oncology, National Institute of Radiological Sciences, Chiba 263-8555, Japan
Hiroko Akamatsu, Ibuki Ota, Yasuhito Hagiwara, Mayumi Ichikawa, Misako Miwa, Shouhei Kawashiro, Kenji Nemoto, Department of Radiation Oncology, Yamagata University Hospital, Yamagata 990-8560, Japan
Motohisa Hagiwara, Masahiro Chin, Eiji Hashizume, Department of Surgery, Nihonkai General Hospital, Yamagata 990-8560, Japan
Author contributions: Nomiya T contributed to the writing of the case report, making conception and design, acquisition of data; Hashizume E, Chin M and Hagiwara M contributed to the clinical work and acquisition of data; Miwa M, Ichikawa M, Hagiwara Y, Ota I, Akamatsu H, Harada M and Kawashiro S contributed to the acquisition of data; and Nemoto K contributed to the interpretation of data and final approval of the manuscript.
Correspondence to: Takuma Nomiya, MD, PhD, Department of Radiation Oncology, National Institute of Radiological Sciences, Research Center Hospital for Charged Particle Therapy, 4-9-1, Anagawa, Inage-ku, Chiba 263-8555, Japan. t_nomiya@nirs.go.jp
Telephone: +81-43-2063360 Fax: +81-43-2066506
Received: May 14, 2014
Revised: June 16, 2014
Accepted: July 15, 2014
Published online: December 28, 2014
Processing time: 236 Days and 18.4 Hours
Abstract

A clinical trial of radiotherapy with modified simultaneous integrated boost (SIB) technique against huge tumors was conducted. A 58-year-old male patient who had a huge pelvic tumor diagnosed as a rectal adenocarcinoma due to familial adenomatous polyposis was enrolled in this trial. The total dose of 77 Gy (equivalent dose in 2 Gy/fraction) and 64.5 Gy was delivered to the center of the tumor and the surrounding area respectively, and approximately 20% dose escalation was achieved with the modified SIB technique. The tumor with an initial maximum size of 15 cm disappeared 120 d after the start of the radiotherapy. Performance status of the patient improved from 4 to 0. Radiotherapy with modified SIB may be effective for patients with a huge tumor in terms of tumor shrinkage/disappearance, improvement of QOL, and prolongation of survival.

Keywords: Clinical trial; Image-guided radiotherapy; Rectal neoplasms; Quality of life; Neoplasm recurrence

Core tip: This paper introduces a new technique of radiation therapy for huge tumors. In the past, patients with radioresistant huge adenocarcinoma could undergo only palliative treatment because huge tumors could not be controlled with a dose less than tolerant dose of healthy tissue. However, this technique enabled to deliver higher-dose to the center of huge tumor without exceeding tolerant dose to the healthy tissue. Of course it is difficult to cure these patients, this technique showed a possibility to control huge tumors. From the patients enrolled in this clinical trial, we introduce a patient with tumor arising from digestive system.