Re-irradiation for recurrent rectal cancer – a single-center experience

Abstract

Background: There is no clear consensus on the use of re-irradiation (reRT) in the management of locally recurrent rectal cancer (LRRC). The aim of the present study was to investigate all reRT administered for rectal cancer at a large referral institution and to evaluate patient outcomes and toxicity. Material and methods: All patients with rectal cancer were identified who had received previous pelvic radiotherapy (RT) and underwent reRT during 2006-2016. Medical records and RT details of the primary tumor treatments and rectal cancer recurrence treatments were registered, including details on reRT, chemotherapy, surgery, adverse events, and long-term outcomes. Results: Of 77 patients who received ReRT, 67 had previously received pelvic RT for rectal cancer and were administered reRT for LRRC. Re-irradiation doses were 30.0-45.0 Gy, most often given as hyperfractionated RT in 1.2-1.5 Gy fractions twice daily with concomitant capecitabine. The median time since initial RT was 29 months (range, 13-174 months). Of 36 patients considered as potentially resectable, 20 underwent surgery for LRRC within 3 months after reRT. Operated patients had better 3-year overall survival (OS) (62%) compared to those who were not operated (16%; HR 0.32, p ¼ .001). The median gross tumor volume (GTV) was 107 cm 3 , and 3-year OS was significantly better in patients with GTV <107 cm 3 (44%) compared to patients with GTV !107 cm 3 (21%; HR 0.52, p ¼ .03). Conclusion: Three-year survival was significantly better for patients who underwent surgery after reRT or who had small tumor volume. Prospective clinical trials are recommended for further improvements in patient selection, outcomes, and toxicity assessment.

Efficacy and toxicity of re-irradiation for esophageal cancer patients with locoregional recurrence: a retrospective analysis

“…But the role of salvage treatments in patients with LR in the primary tumor bed after RT is controversial [ 21 ]. Re-irradiation has been successfully used in many recurrent tumors of various sites with the development of radiotherapy techniques, such as head and neck cancer [ 7 , 22 ], high grade glioma [ 23 ], lung cancer [ 24 ], intracranial germ-cell tumors [ 25 ], rectal cancer [ 26 , 27 ] and paediatric tumor [ 28 ] with encouraging results. Several small size retrospective studies reported the outcome of re-RT of LR for ESCC patients received RT [ 14 , 17 , 29 ].…”

Particle beam therapy for pelvic recurrence of colorectal cancer: a registry data analysis in Japan and a systematic review

“…The frequency of late GI toxicity was similar for XRT and PBT, 0–7%. However, a high incidence of Grade 3 or higher fistula formation was reported in the group of patients treated with concurrent chemotherapy and re-irradiation, who received a median dose of 50 Gy of XRT [ 43 ].…”

Development of a consensus-based delineation guideline for locally recurrent rectal cancer

“…[1,2,6,7] Currently, neoadjuvant chemoradiotherapy (nCRT) is an integral part of LRRC treatment. [2,[8][9][10][11][12][13][14][15][16] In radiotherapy naïve patients, nCRT is advised to downstage tumour volume and increase the likelihood of a radical resection (R0), which is the most important prognostic factor for survival. [1,4] Reirradiation in the setting of LRRC is feasible and safe, confirmed by low toxicity rates seen in the first prospective re-irradiation feasibility trial for LRRC performed by Valentini et al [17] Although re-irradiation does show encouraging results, the clinical benefit of re-irradiation is yet to be proven, as nCRT has not yet shown an effect on OS.…”