Curative surgical resection following reirradiation for recurrent rectal cancer

Mohiuddin, Mohammed; Marks, Gerald; Lingareddy, Vasudha; Marks, John

doi:10.1016/s0360-3016(97)00340-4

Cited by 86 publications

(42 citation statements)

References 32 publications

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“…Third, hyperfractionation has been used to decrease tumor bulk and decrease late complications due to the favorable biologic effects of smaller fraction sizes [15,16], as has been shown in head and neck tumors [17]. Lingareddy et al followed 52 rectal cancer patients of whom 42% received twice-daily radiation therapy and found that hyperfractionated radiation therapy reduced late toxicity [18].…”

Section: Discussionmentioning

confidence: 99%

Proton Reirradiation of Recurrent Rectal Cancer: Dosimetric Comparison, Toxicities, and Preliminary Outcomes

Berman¹,

Both²,

Sharkoski³

et al. 2014

International Journal of Particle Therapy

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Purpose: Locally advanced rectal adenocarcinoma is effectively treated with chemoradiation and surgery; however, 10 to 25% of patients locally recur within or near a previously irradiated field. Proton radiation therapy (PRT) is ideally suited to the problem of reirradiation for locally recurrent rectal cancer (LRRC). Patients and Methods: Seven patients with LRRC in or near prior radiation fields were enrolled on this prospective study from March 2010 to February 2011. All patients underwent positron emission tomography (PET)/computed tomography (CT) simulation and were stratified by low volume (clinical target volume,250 cm 3 , n¼4) or high volume (.250 cm 3 , n¼3). Primary endpoints were feasibility and acute toxicity (within 90 days from PRT initiation). Dosimetry was compared using the Wilcoxon signed-rank test. Tumor response was defined according to PERCIST criteria. Results: Median follow-up was 14 months (4.9-22.6). Median dose of prior RT was 5040 cGy. Mean PRT dose was 6120 cGy (RBE) (range, 4500-6480 cGy). The total dose sum of prior radiation therapy treatment and PRT was 109.8 Gy (RBE) (range, 95.4-151.2). One patient had surgery prior to and 1 after PRT. Six patients received concurrent 5-fluorouracil-based chemotherapy. Bowel volume receiving 10 and 20 Gy, and the dose to 200 and 150 cm 3 of bowel were significantly reduced. There were 3 acute grade 3 and 3 late grade 4 toxicities. Four patients were alive at time of follow-up. Six had a metabolic complete response, of whom 2 subsequently locally recurred. One had initial progressive disease. Of 6 symptomatic patients, 3 had complete pain resolution and 3 partial.Conclusions: This preliminary report indicates that PRT for LRRC provides dosimetric improvements over intensity-modulated radiation therapy, particularly to the bowel. The modest rates of acute and late toxicity as well as the preliminary outcomes of high tumor and symptom control rates are promising.

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Section: Discussionmentioning

confidence: 99%

Proton Reirradiation of Recurrent Rectal Cancer: Dosimetric Comparison, Toxicities, and Preliminary Outcomes

Berman¹,

Both²,

Sharkoski³

et al. 2014

International Journal of Particle Therapy

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“…However, considerable recent experience indicates that selective reirradiation and chemotherapy is feasible, with the potential for curative re-resection even after a cumulative radiation dose of 70 to 100 Gy. 29 With the use of three-dimensional treatment planning, portals can be designed to limit the dose to previously irradiated sensible organs. 3° Additionally, hyperfractionated radiation delivery, for example, 1.2 Gy twice daily up to a total dose of 30 to 40 Gy, seems to minimize late normal tissue toxicity, which is the critical limiting factor.31 CONCLUSION A combination of high-dose preoperative CRT followed by maximum surgery can be administered safely to patients with advanced recurrent rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Extensive surgery after high-dose preoperative chemoradiotherapy for locally advanced recurrent rectal cancer

Rödel¹,

Grabenbauer²,

Matzel³

et al. 2000

Diseases of the Colon &Amp; Rectum

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“…Importantly, the possibility of radical resection was significantly higher in patients attaining CR or PR, and 5-year actuarial survival was 66.8% in patients achieving R0 resection as compared to 22.3% in patients undergoing no resection or subtotal tumor resection. Mohiuddin et al [41] studied 39 patients with recurrent rectal adenocarcinoma after previous adjuvant therapy who underwent reirradiation of the pelvis with concurrent intravenous infusion of 5-fluorouracil. In this study, 31 patients had gross total resection of tumor, with 5-year actuarial survival of 24% and no surgical mortality.…”

Section: Role Of Preoperative Chemoradiationmentioning

confidence: 99%

Salvage of pelvic recurrence of colorectal cancer

Varker¹,

Wanebo²

2010

Journal of Surgical Oncology

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Although the incidence of locally recurrent colorectal cancer has been reduced by improved surgical techniques and the frequent use of multimodality therapy, pelvic recurrence remains a significant problem. Radiation or chemotherapy may provide palliation but it is often short-lived. For fit candidates without evidence of extrapelvic disease, surgical resection (anterior resection, abdominoperineal resection, pelvic exenteration, or abdominosacral resection) may be the most appropriate treatment. For patients with unresectable disease, isolated pelvic perfusion may provide effective palliation.

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Curative surgical resection following reirradiation for recurrent rectal cancer

Cited by 86 publications

References 32 publications

Proton Reirradiation of Recurrent Rectal Cancer: Dosimetric Comparison, Toxicities, and Preliminary Outcomes

Proton Reirradiation of Recurrent Rectal Cancer: Dosimetric Comparison, Toxicities, and Preliminary Outcomes

Extensive surgery after high-dose preoperative chemoradiotherapy for locally advanced recurrent rectal cancer

Salvage of pelvic recurrence of colorectal cancer

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