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For radiotherapy, oesophageal cancer is located in a difficult area. Spatial control of the dose distribution is difficult to achieve with current CT-based radiation techniques, as on CT, soft-tissue contrast is too low. Furthermore, the oesophagus moves and organs at risk (e.g. lung, heart, liver, spinal cord) are in close proximity. An 1.5 T MRI-accelerator (MRL) has sufficient soft-tissue tumour visualization possibilities to allow for precise real-time, online, position verification and for dose escalation without organ at riskoverdose. Our research consists of the preparatory work for the first clinical study on the MRL for patients with oesophageal cancer. To improve image quality and reduce the motion artefacts, the benefit of cardiac triggering and breath holds is evaluated on fifteen oesophageal patients. Results show the superb image quality of these MRI sequences. The use of this high quality MRI gives the possibility for non-invasive real-time visualization andtracking of the tumour. We quantify oesophageal tumour motion on cineMRI. The tumour is tracked on sequential mixed T1/T2w images (acquisition time: 60s, temporal resolution: 0.5s, slice thickness: 7mm) of a single coronal and sagittal slice using a Minimum Output Sum of Squared Error (MOSSE) adaptive correlation filter. Tumour registration within the individual images can typically be done at a millisecond time scale. Motion of oesophageal tumours can well be tracked and is highly variable between patients. The greatest mobility is seen in cranio-caudal direction, with amaximum peak-to-peak amplitude of tumour movement of 24.5mm followed by the dorso-ventral and the medio-lateral direction. Movement seems greatest in tumours located in the lower part of the oesophagus. This study shows both the superb image quality for GTV localisation and the possibility for on-line and real time tumour tracking. The study opens thepossibility for tracked radiation delivery with a 1.5T MRI accelerator. Partial funding has been obtained by Elekta and Philips.

Background Treatment for locally advanced rectal cancer (LARC) consists of chemoradiation therapy (CRT) and surgery. Approximately 15% of patients show a pathological complete response (pCR). Increased pCR-rates can be achieved through dose escalation, thereby increasing the number patients eligible for organ-preservation to improve quality of life (QoL). A randomized comparison of 65 versus 50Gy with external-beam radiation alone has not yet been performed. This trial investigates pCR rate, clinical response, toxicity, QoL and (disease-free) survival in LARC patients treated with 65Gy (boost + chemoradiation) compared with 50Gy standard chemoradiation (sCRT). Methods/design This study follows the ‘cohort multiple randomized controlled trial’ (cmRCT) design: rectal cancer patients are included in a prospective cohort that registers clinical baseline, follow-up, survival and QoL data. At enrollment, patients are asked consent to offer them experimental interventions in the future. Eligible patients—histologically confirmed LARC (T3NxM0

Background For esophageal cancer patients, radical esophagolymphadenectomy is the cornerstone of multimodality treatment with curative intent. Transthoracic esophagectomy is the preferred surgical approach worldwide allowing for en-bloc resection of the tumor with the surrounding lymph nodes. However, the percentage of cardiopulmonary complications associated with the transthoracic approach is high (50 to 70%). Recent studies have shown that robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RATE) is at least equivalent to the open transthoracic approach for esophageal cancer in terms of short-term oncological outcomes. RATE was accompanied with reduced blood loss, shorter ICU stay and improved lymph node retrieval compared with open esophagectomy, and the pulmonary complication rate, hospital stay and perioperative mortality were comparable. The objective is to evaluate the efficacy, risks, quality of life and cost-effectiveness of RATE as an alternative to open transthoracic esophagectomy for treatment of esophageal cancer. Methods/design This is an investigator-initiated and investigator-driven monocenter randomized controlled parallel-group, superiority trial. All adult patients (age ≥18 and ≤80 years) with histologically proven, surgically resectable (cT1-4a, N0-3, M0) esophageal carcinoma of the intrathoracic esophagus and with European Clinical Oncology Group performance status 0, 1 or 2 will be assessed for eligibility and included after obtaining informed consent. Patients (n = 112) with resectable esophageal cancer are randomized in the outpatient department to either RATE (n = 56) or open three-stage transthoracic esophageal resection (n = 56). The primary outcome of this study is the percentage of overall complications (grade 2 and higher) as stated by the modified Clavien–Dindo classification of surgical complications. Discussion This is the first randomized controlled trial designed to compare RATE with open transthoracic esophagectomy as surgical treatment for resectable esophageal cancer. If our hypothesis is proven correct, RATE will result in a lower percentage of postoperative complications, lower blood loss, and shorter hospital stay, but with at least similar oncologic outcomes and better postoperative quality of life compared with open transthoracic esophagectomy. The study started in January 2012. Follow-up will be 5 years. Short-term results will be analyzed and published after discharge of the last randomized patient. Trial registration Dutch trial register: NTR3291 ClinicalTrial.gov: NCT01544790