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Advances in chemoradiation therapy in rectal cancer: the impact of imaging

Department of Radiotherapy, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK

View larger version (119K): [in a new window]   Figure 1. (a) MRI of a T2 N0 tumour deemed operable by MR appearance, with no poor prognostic features. (b) MRI of a bulky, circumferential, rectal cancer with features indicating invasion into the mesorectal fascia and close circumferential resection margins. (c) MRI appearance of locally advanced rectal cancer with extension of disease to the left pelvic side wall, making this an inoperable cancer.

View larger version (135K): [in a new window]   Figure 2. (a) CT appearance of liver showing suspicious solitary metastasis. (b) Tesla MRI of equivalent slices confirming the CT suspected lesion and identifying a further lesion in the left lobe.

View larger version (42K): [in a new window]   Figure 3. (a) Transaxial CT planning scan slice showing the Phase I volume with the achievable anterior border, without the desired concavity. (b) Sagittal CT reconstruction showing a Phase I volume with an achievable concavity on the anterior aspect.

View larger version (123K): [in a new window]   Figure 4. Digitally reconstructed radiograph showing a lateral beam shaped by multileaf collimation.

View larger version (90K): [in a new window]   Figure 5. Lateral view of a Phase II reconstructed target volume.

View larger version (67K): [in a new window]   Figure 6. Transaxial CT planning slice showing the target volume achievable with intensity-modulated radiotherapy, in particular the anterior border has a concavity not achievable with standard conformal techniques.

View larger version (109K): [in a new window]   Figure 7. Transaxial CT planning scan showing combined Phase I and II dosimetry for an intensity-modulated radiotherapy treatment plan.