Palliative reirradiation for recurrent rectal cancer

Lingareddy, Vasudha; Ahmad, Neelofur; Mohiuddin, Mohammed

doi:10.1016/s0360-3016(97)00058-8

Cited by 118 publications

(61 citation statements)

References 39 publications

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“…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]. We used once-daily fractionation, leaving the outstanding question of the relative importance of the physical properties of PRT versus the biologic properties of hyperfractionation.…”

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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“…[17] Hipertermi veya (intraoperatif RT) IORT ile birlikte yapılabilen tekrar radyoterapisi ve cerrahi birlikteliğinde beş yıllık sağkalım %40, grade III toksisite %5-15'ten az olarak bildirilmiştir [31][32][33] Cerrahiyle birlikte IORT kullanımında makul lokal kontrol oranlarının bildirildiği birçok çalışma mevcuttur. [34][35][36][37][38] Ancak daha yakın bir zamanda yayınlanan bir olgu çalışmasında lokal başarısızlık oranı %53 gibi yüksek bir oranda bildirilmiştir.…”

Section: Discussionunclassified

Is stereotactic body radiotherapy a treatment option for pelvic recurrences?

Dağoğlu¹

2015

TJ Oncol

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KliNiK ÇalIŞma ORIGINAL ARTICLE oBJeCtIVeSWhen surgery is not adequate, stereotactic body radiotherapy (SBRT) has been used for recurrent cancers. We report the outcomes of case series with pelvic recurrences from colorectal cancer irradiated with SBRT. metHoDSRobotic Stereotactic Radiotherapy system was used. The dose fractionation scheme was individualized based on tumor volume and location and prior radiation dose. reSultSBetween February 2010 and December 2014, four patients were treated. Treatment regions were pelvic side wall for two patients and presacral for two patients. SBRT doses were 24 Gy in 3 fractions for three patients and 36.25 Gy in 5 fractions for one patient.One patient treated for pelvic side wall recurrence developed symptomatic noropathy at fist year. CoNCluSIoNLocal recurrence in pelvis after modern combined modality treatment for colorectal cancer is rare. However it presents a therapeutic dilemma when it occurs; often symptomatic and eventually life threatening. SBRT can be a useful modality in this setting.

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“…The results of the reirradiated patients were not reported separately; only González González et al reported better palliative effects with higher radiation doses. In the study by Lingareddy et al, 24 all patients were treated with reirradiation. Those investigators used lower fraction sizes (twice-daily 1.2 Gy or once-daily 1.8 or 2.0 Gy) and gave concurrent 5-fluorouracil to 90% of their patients.…”

Section: Discussionmentioning

confidence: 99%

Reirradiation and hyperthermia in rectal carcinoma

Juffermans

Hanssens

Putten

et al. 2003

Cancer

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BACKGROUNDThe objective of this study was to evaluate the palliative effect of reirradiation and hyperthermia in patients with unresectable, recurrent colorectal carcinoma.METHODSThe medical records of 54 patients with unresectable, recurrent colorectal carcinoma that caused pain and who were treated with reirradiation and hyperthermia, were evaluated retrospectively. Previous radiotherapy was given up to a total dose ranging from 25–70 grays (Gy). The median interval between prior radiotherapy and reirradiation was 22 months (range, 4–97 months). The total reirradiation dose varied from 24 Gy to 32 Gy given in fractions of 4 Gy twice weekly. Three or four hyperthermia treatments were given once weekly. Toxicity was registered. The influence of World Health Organization (WHO) performance status, maximum tumor dimension, and time between first radiotherapy and reirradiation on therapeutic outcome was evaluated. The results of this study were compared with published results on patients who received radiotherapy with or without hyperthermia.RESULTSForty‐seven patients (87%) completed the planned treatment schedule. The maximum toxicity was Grade 2. All patients were evaluated for palliative effect. The median follow‐up was 10 months. A good or complete palliative effect was achieved in 72% of patients for a median duration of 6 months. Patients who had a better WHO performance status, smaller tumors, and a longer interval between first radiotherapy and reirradiation had slightly better outcomes, although none of those parameters reached statistical significance.CONCLUSIONSThe described combined treatment was feasible and well tolerated. Comparison of results from radiotherapy plus hyperthermia with results after radiotherapy alone suggested that additional hyperthermia prolonged the duration of palliation. Firm proof of the contribution of hyperthermia will require performing a Phase III study. Cancer 2003. © 2003 American Cancer Society.DOI 10.1002/cncr.11719

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Palliative reirradiation for recurrent rectal cancer

Cited by 118 publications

References 39 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

Is stereotactic body radiotherapy a treatment option for pelvic recurrences?

Reirradiation and hyperthermia in rectal carcinoma

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