Local Therapy Options for Recurrent Rectal and Anal Cancer: Current Strategies and New Directions

Dee, Edward Christopher; Eyler, Christine E.; Sanford, Nina N.; Wo, Jennifer Y.

doi:10.1007/s11888-019-00445-z

Cited by 3 publications

(7 citation statements)

References 137 publications

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“…Despite generally good outcomes after primary chemoradiation without surgery for primary anal cancer, consistent with the ACT II results [ 125 ], studies demonstrate persistent disease in 10–15% of patients [ 28 , 126 , 127 , 128 ]. The primary treatment for persistent disease is APR [ 129 ].…”

Section: Treatment Of Persistent/recurrent Diseasementioning

confidence: 58%

“…Furthermore, among patients who received primary chemoradiotherapy for anal cancer, multiple retrospective series show that 10–30% of patients may experience recurrent disease [ 72 , 128 ]. Similar to persistent disease, salvage APR is a potentially curative option for locally recurrent anal cancer with 5-year overall survival of 40–60% [ 69 , 128 , 130 , 131 , 132 ]. Other series report survival of over 80% [ 128 , 133 , 134 , 135 , 136 ].…”

Section: Treatment Of Persistent/recurrent Diseasementioning

confidence: 99%

“…Efforts have been made to identify differences in outcome comparing persistent vs. recurrent disease [ 128 ]. Although some studies demonstrate no survival difference among patients who receive salvage APR for persistent vs. recurrent disease [ 135 , 137 , 138 ], others suggest that persistent disease or early recurrence may be associated with worse outcomes, possibly due to more aggressive tumor biology in persistent disease or early recurrence [ 132 , 133 , 139 , 140 ].…”

Section: Treatment Of Persistent/recurrent Diseasementioning

confidence: 99%

“…Treatment of locally recurrent anal cancer with external beam re-irradiation and/or intra-operative radiotherapy (IORT) is merits further study [ 128 ]. A cohort of 10 patients with locally recurrent anal cancer who received at least 30 Gy to the primary lesion received an additional 27–45 Gy re-irradiation for recurrent disease [ 150 ].…”

Section: Treatment Of Persistent/recurrent Diseasementioning

confidence: 99%

“…At our institution, IMRT and/or proton radiotherapy are considered when re-irradiating locally recurrent disease, with treatment delivered to gross disease only [ 128 ]. A report of patients with locally recurrent anal cancer treated with IORT found that although 50% demonstrated positive resection margins, fewer than a quarter experienced recurrence within the IORT treatment field, suggesting a benefit from IORT [ 129 ].…”

Section: Treatment Of Persistent/recurrent Diseasementioning

confidence: 99%

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Evolution of the Role of Radiotherapy for Anal Cancer

Dee

Byrne

2021

Cancers

Self Cite

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Prior to the 1980s, the primary management of localized anal cancer was surgical resection. Dr. Norman Nigro and colleagues introduced neoadjuvant chemoradiotherapy prior to abdominoperineal resection. Chemoradiotherapy 5-fluorouracil and mitomycin C afforded patients complete pathologic response and obviated the need for upfront surgery. More recent studies have attempted to alter or exclude chemotherapy used in the Nigro regimen to mitigate toxicity, often with worse outcomes. Reductions in acute adverse effects have been associated with marked advancements in radiotherapy delivery using intensity-modulated radiation therapy (IMRT) and image-guidance radiation delivery, resulting in increased tolerance to greater radiation doses. Ongoing trials are attempting to improve IMRT-based treatment of locally advanced disease with efforts to increase personalized treatment. Studies are also examining the role of newer treatment modalities such as proton therapy in treating anal cancer. Here we review the evolution of radiotherapy for anal cancer and describe recent advances. We also elaborate on radiotherapy’s role in locally persistent or recurrent anal cancer.

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Section: Treatment Of Persistent/recurrent Diseasementioning

confidence: 58%

Section: Treatment Of Persistent/recurrent Diseasementioning

confidence: 99%

Section: Treatment Of Persistent/recurrent Diseasementioning

confidence: 99%

Section: Treatment Of Persistent/recurrent Diseasementioning

confidence: 99%

Section: Treatment Of Persistent/recurrent Diseasementioning

confidence: 99%

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Evolution of the Role of Radiotherapy for Anal Cancer

Dee

Byrne

2021

Cancers

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Dutch national guidelines for locally recurrent rectal cancer

Piqeur,

Creemers,

Banken

et al. 2024

Cancer Treatment Reviews

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Proton Beam Therapy for Esophageal Cancer

Solidum

Rojo

et al. 2022

Cancers

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Early-stage esophageal cancer is often primarily managed surgically, with the addition of radiotherapy for locally advanced disease. However, current photon-based radiotherapy regimens and surgery results in a high incidence of treatment-related cardiac and pulmonary complications due to the involvement of proximal organs at risk. In addition, the anatomic location of the esophagus raises challenges for radiotherapy due to the anatomical changes associated with diaphragmatic motion, weight loss, tumor changes, and set-up variability. These challenges propelled the interest in proton beam therapy (PBT), which theoretically offers a reduction in the radiation exposure to healthy neighboring tissues with improvements in the therapeutic ratio. Several dosimetric studies support the potential advantages of PBT for esophageal cancer treatment however, translation of these results to improved clinical outcomes remains unclear with limited clinical data, especially in large populations. Studies on the effect on quality of life are likewise lacking. Here, we review the existing and emerging role of PBT for esophageal cancer, including treatment planning, early clinical comparisons of PBT with photon-based techniques, recently concluded and ongoing clinical trials, challenges and toxicities, effects on quality of life, and global inequities in the treatment of esophageal cancer.

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Local Therapy Options for Recurrent Rectal and Anal Cancer: Current Strategies and New Directions

Cited by 3 publications

References 137 publications

Evolution of the Role of Radiotherapy for Anal Cancer

Evolution of the Role of Radiotherapy for Anal Cancer

Dutch national guidelines for locally recurrent rectal cancer

Proton Beam Therapy for Esophageal Cancer

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