Re-irradiation With Carbon Ion Radiotherapy for Pelvic Rectal Cancer Recurrences in Patients Previously Irradiated to the Pelvis (original) (raw)
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Cancers
No standard treatment paradigm exists for previously irradiated locally recurrent rectal cancer (PILRRC). Carbon-ion radiotherapy (CIRT) may improve oncologic outcomes and reduce toxicity compared with combined modality therapy (CMT). Eighty-five patients treated at Institution A with CIRT alone (70.4 Gy/16 fx) and eighty-six at Institution B with CMT (30 Gy/15 fx chemoradiation, resection, intraoperative electron radiotherapy (IOERT)) between 2006 and 2019 were retrospectively compared. Overall survival (OS), pelvic re-recurrence (PR), distant metastasis (DM), or any disease progression (DP) were analyzed with the Kaplan–Meier model, with outcomes compared using the Cox proportional hazards model. Acute and late toxicities were compared, as was the 2-year cost. The median time to follow-up or death was 6.5 years. Median OS in the CIRT and CMT cohorts were 4.5 and 2.6 years, respectively (p ≤ 0.01). No difference was seen in the cumulative incidence of PR (p = 0.17), DM (p = 0.39), ...
BMC Cancer, 2012
Background: Treatment standard for patients with rectal cancer depends on the initial staging and includes surgical resection, radiotherapy as well as chemotherapy. For stage II and III tumors, radiochemotherapy should be performed in addition to surgery, preferentially as preoperative radiochemotherapy or as short-course hypofractionated radiation. Advances in surgical approaches, especially the establishment of the total mesorectal excision (TME) in combination with sophisticated radiation and chemotherapy have reduced local recurrence rates to only few percent. However, due to the high incidence of rectal cancer, still a high absolute number of patients present with recurrent rectal carcinomas, and effective treatment is therefore needed. Carbon ions offer physical and biological advantages. Due to their inverted dose profile and the high local dose deposition within the Bragg peak precise dose application and sparing of normal tissue is possible. Moreover, in comparison to photons, carbon ions offer an increase relative biological effectiveness (RBE), which can be calculated between 2 and 5 depending on the cell line as well as the endpoint analyzed. Japanese data on the treatment of patients with recurrent rectal cancer previously not treated with radiation therapy have shown local control rates of carbon ion treatment superior to those of surgery. Therefore, this treatment concept should also be evaluated for recurrences after radiotherapy, when dose application using conventional photons is limited. Moreover, these patients are likely to benefit from the enhanced biological efficacy of carbon ions.
Re-irradiation in recurrent rectal cancer: single institution experience
Translational Gastrointestinal Cancer, 2014
To determine the rates of acute and late toxicity, the efficacy to relieve symptoms, progression free survival, and over all survival in rectal cancer patients treated with re-irradiation. Patients and methods: Between June 2009 and December 2012, 32 patients with recurrent rectal cancer previously treated with pelvic irradiation, were treated with 180 cGy/fraction, with a total dose 39 Gy if the treatment interval ≥1 year, and 30 Gy if interval <1 year. The dose was delivered to planning target volume (PTV) including gross target volume plus 2-3 cm margin. Concurrent chemotherapy was administrated in first five days of radiotherapy. Patients were evaluated during and after completion of treatment for acute, late toxicity, and response. Results: Re-irradiation was well tolerated, no grade 4 toxicity was recorded, most toxicities were mild (grade 1-2), only 6.2% developed grade 3 acute gastrointestinal and 6.2% developed grade 3 late skin toxicity. Symptoms were effectively palliated, bleeding was relieved in 100%, and 80% recovered of pain symptoms. Two years rates of progression free survival and overall survival were 21% and 38% respectively. Interval to reirradiation, previous radiation dose, and total radiation dose showed significant relation with overall survival. Conclusions: Re-irradiation in recurrent rectal cancer was well tolerated with mild rates of acute and late toxicities. Bleeding and pain were well controlled.
La radiologia medica
Purpose Radical resection (R0) represents the best curative treatment for local recurrence (LR) rectal cancer. Re-irradiation (re-RT) can increase the rate of R0 resection. Currently, there is a lack of guidelines on Re-RT for LR rectal cancer. The Italian Association of Radiation and clinical oncology for gastrointestinal tumors (AIRO-GI) study group released a national survey to investigate the current clinical practice of external beam radiation therapy in these patients. Material and methods In February 2021, the survey was designed and distributed to members of the GI working group. The questionnaire consisted of 40 questions regarding center characteristics, clinical indications, doses, and treatment techniques of re-RT for LR rectal cancer. Results A total of 37 questionnaires were collected. Re-RT was reported as an option for neoadjuvant treatment in resectable and unresectable disease by 55% and 75% of respondents, respectively. Long-course treatment with 30–40 Gy (1.8–2 G...
Outcomes following a limited approach to radiotherapy in rectal cancer
British Journal of Surgery, 2011
Background: Variation in the use of neoadjuvant and adjuvant radiotherapy for rectal cancer suggests an opportunity to avoid it in all but patients at highest risk of local recurrence. Methods: Between 1 July 1999 and 1 February 2006, patients with primary rectal cancer were treated by a single surgeon operating at McMaster University, Hamilton, Ontario, Canada. Digital rectal examination and pelvic computed tomography were used to determine whether the mesorectal margin was threatened by tumour and thus whether preoperative radiotherapy would be needed. The study outcome was local tumour recurrence.
International Journal of Radiation Oncology*Biology*Physics, 2013
Recognition of the high risk of local rerecurrence and death in locally recurrent rectal cancer has led to interest in the use of radical intent surgical resection, external beam radiation therapy and intraoperative electron beam radiation therapy. These mature data add further evidence that intensified radiation and surgical treatment promotes locoregional control, compensating some adverse disease features in the Purpose: To analyze prognostic factors associated with survival in patients after intraoperative electrons containing resective surgical rescue of locally recurrent rectal cancer (LRRC). Methods and Materials: From January 1995 to December 2011, 60 patients with LRRC underwent extended surgery (nZ38: multiorgan [43%], bone [28%], soft tissue [38%]) or nonextended (nZ22) surgical resection, including a component of intraoperative electron-beam radiation therapy (IOERT) to the pelvic recurrence tumor bed. Twenty-eight (47%) of these patients also received external beam radiation therapy (EBRT) (range, 30.6-50.4 Gy). Survival outcomes were estimated by the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: The median follow-up time was 36 months (range, 2-189 months), and the 1-year, 3year, and 5-year rates for locoregional control (LRC) and overall survival (OS) were 86%, 52%, and 44%; and 78%, 53%, 43%, respectively. On multivariate analysis, R1 resection, EBRT at the time of pelvic rerecurrence, no tumor fragmentation, and non-lymph node metastasis retained significance with regard to LRR. R1 resection and no tumor fragmentation showed a significant association with OS after adjustment for other covariates. Conclusions: EBRT treatment integrated for rescue, resection radicality, and not involved fragmented resection specimens are associated with improved LRC in patients with locally recurrent rectal cancer. Additionally, tumor fragmentation could be compensated by EBRT. Present results
Late sacral recurrence of rectal cancer treated by heavy ion radiotherapy: a case report
Surgical case reports, 2016
The need for surveillance of rare late recurrence of rectal cancer has not yet been established. Local control of unresectable skeletal metastasis is important for palliation of symptoms and support for systemic chemotherapy. A Japanese man underwent preoperative pelvic irradiation (50.4 Gy/28 Fr) and low anterior resection at the age of 57 years. The pathological stage was II (T3N0M0). Nine years after the surgery, his carcinoembryonic antigen (CEA) level showed rapid elevation, although he had no symptoms. A computed tomography (CT) scan showed no evidence of recurrent lesions, but positron emission tomography (PET)-CT revealed abnormally high 2-[(18)F]-fluoro-2-deoxy-D-glucose accumulation in the sacrum. A CT-guided needle biopsy confirmed the diagnosis of metastatic adenocarcinoma from the previous rectal cancer. The sacral metastasis reached the S1/S2 level and was considered inoperable. Conventional radiotherapy was also excluded due to the previous history of pelvic irradiati...
International Journal of Radiation Oncology*Biology*Physics, 1992
A group of 95 patients, treated with irradiation for relapse after radical surgery as only initial treatment modality for a rectal carcinoma was studied. The term locoregional relapse relates to evidence of tumor recurrent in the pelvis or the perineal area. Seventy-six patients presented with locoregional relapse only, and 19 patients presented with locoregional relapse and concomitant distant metastases. All patients were irradiated at the site of locoregional relapse. Total dose of irradiation was resp. 44 Gy median (range 6-66 Cy) and 40 Gy median (range 6-50 Gy). In the group of patients with locoregional relapse only, recurrence-free survival and survival after radiotherapy were, respectively, 23% and 61% at 1 year, and 6% and 13% at 3 years. In the group of patients with concomitant distant metastases, survival after radiotherapy was even worse, 33% at one year, and nihil at 3 years. Recurrences after radiotherapy occurred early during follow-up with 75% of the recurrences being recorded during the first year of follow-up. Recurrent or persistent disease inside the irradiation volume was the most important clinical problem in both groups, being documented in, respectively, 43/76 and 7/19 (7/13 if six patients were excluded with a survival of less than 3 months from onset of therapy). In the group of patients with locoregional relapse only, using recurrence-free survival as the endpoint, dose of irradiation (p = 0.01) was a significant multivariate prognostic factor and using survival as the endpoint, dose of irradiation (p = 0.005) and grade of tumor differentiation (p = 0.002) were significant. Potentials of current radiotherapy regimes are limited. Therefore, maximal initial treatment is warranted. In the event of a relapse after initial radical surgery, one should opt for either more aggressive standard therapy, or either new combined modalities approaches should be studied. Radiotherapy, Locoregional relapse, Rectal carcinoma.
Advances in Radiotherapy in Operable Rectal Cancer
Digestive Surgery, 2009
rent long-course chemoradiotherapy. As survival is only marginally affected despite low local recurrence, future trials should aim to address metastatic disease. End points which incorporate function and quality of life must be used.