Safety and Efficacy of Re-irradiation With Carbon-ion Radiotherapy for Pelvic Recurrence of Rectal Cancer After Preoperative Chemoradiotherapy: A Retrospective Analysis

Shiba, Shintaro; Okamoto, Masahiko; Shibuya, Kazuhiko; Okazaki, Shohei; Kobayashi, Daijiro; Miyasaka, Yasuhiro; Ohno, Tatsuya

doi:10.21873/invivo.12983

Cited by 9 publications

(6 citation statements)

References 28 publications

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“…Therefore, our cohort might have more treatment-resistant, aggressive biological recurrent tumors than previous reports. In addition, the median GTV (26.1 cm 3 ) of ours was slightly larger than those of SABR (13.4 cm 3 ) and CIRT (15.6 cm 3 ) studies [ 5 , 25 ] ( Table 1 ). As a result, we considered that the clinical outcomes in our study were slightly lower than those of photon SABR and CIRT.…”

Section: Discussioncontrasting

confidence: 61%

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Proton beam reirradiation for locally recurrent rectal cancer patients with prior pelvic irradiation

Takagawa,

Suzuki,

Seto

et al. 2024

Journal of Radiation Research

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The aim of the present study was to report the feasibility of proton beam reirradiation for patients with locally recurrent rectal cancer (LRRC) with prior pelvic irradiation. The study population included patients who were treated with proton beam therapy (PBT) for LRRC between 2008 and December 2019 in our institution. Those who had a history of distant metastases of LRRC, with or without treatment, before reirradiation, were excluded. Overall survival (OS), progression-free survival (PFS) and local control (LC) were estimated using the Kaplan–Meier method. Ten patients were included in the present study. The median follow-up period was 28.7 months, and the median total dose of prior radiotherapy (RT) was 50 Gy (range, 30 Gy–74.8 Gy). The median time from prior RT to reirradiation was 31.5 months (range, 8.1–96.6 months), and the median reirradiation dose was 72 Gy (relative biological effectiveness) (range, 56–77 Gy). The 1-year/2-year OS, PFS and LC rates were 100%/60.0%, 20.0%/10.0% and 70.0%/58.3%, respectively, with a median survival time of 26.0 months. Seven patients developed a Grade 1 acute radiation dermatitis, and no Grade ≥ 2 acute toxicity was recorded. Grade ≥ 3 late toxicity was recorded in only one patient, who had developed a colostomy due to radiation-related intestinal bleeding. Reirradiation using PBT for LRRC patients who had previously undergone pelvic irradiation was feasible. However, the indications for PBT reirradiation for LRRC patients need to be considered carefully due to the risk of severe late GI toxicity.

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Section: Discussioncontrasting

confidence: 61%

“…Shiba et al . demonstrated reirradiation with CIRT for seven patients with LRRC after preoperative chemoradiotherapy [ 25 ]. They stated that 2-year OS, LC and PFS rates were 100, 83.3 and 28.6%, respectively (the median follow-up period was 30.9 months).…”

Section: Discussionmentioning

confidence: 99%

Proton beam reirradiation for locally recurrent rectal cancer patients with prior pelvic irradiation

Takagawa,

Suzuki,

Seto

et al. 2024

Journal of Radiation Research

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“…In cases where the tumor is in close proximity with the intestinal tract but does not directly invade the tumor, recent efforts have expanded the indication of CIRT by physically separating the tumor from the surrounding organs with high risk of irradiation adverse effects using spacer insertion before CIRT [ 22 , 23 ]. However, this spacer cannot be used when the recurrent lesion has directly invaded the organs at risk of irradiation adverse effects, as in this case owing to the increased risk of recurrent cancer seeding and infectious complications associated with intestinal tract injury during spacer placement surgery.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary management of locally recurrent rectal cancer with carbon ion radiotherapy followed by prophylactic removal of the irradiated bowel: a case report

Nagata,

Takiyama,

Tashiro

et al. 2024

surg case rep

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Background Locally recurrent rectal cancer (LRRC) involving the upper sacrum is typically incurable, and palliative treatment is the only option for most patients, resulting in a poor prognosis and reduced quality of life. Carbon ion radiotherapy (CIRT) has emerged as a promising modality for treating LRRC. This report presents a case of LRRC with sacral involvement that was managed via multidisciplinary therapy incorporating CIRT. Case presentation A 55-year-old male was diagnosed with an anastomotic recurrence of rectal cancer 15 months after undergoing anterior resection. Computed tomography (CT) suggested that the lesion was at an anastomosis site and broadly adherent to the upper sacrum, and colonoscopy confirmed the diagnosis of LRRC. Histopathological examination of the biopsy specimens revealed adenocarcinoma cells and that lesion was genetically RAS-wild. Induction chemotherapy with mFOLFOX6 and panitumumab was used as the first treatment. The recurrent lesion shrank and no signs of distant metastasis were observed after 11 cycles, although the range of the lesions attached to the sacrum remained unchanged. Therefore, we provided CIRT for this inoperable lesion and prophylactically removed the radiation-exposed bowel including the recurrent lesion, because radiation-induced ulcers can cause bleeding and perforation. Despite the presence of considerable fibrosis in the irradiated region, the operation was successful and the postoperative course had no untoward incidents. He is still recurrence-free 24 months following surgery, despite the lack of adjuvant chemotherapy. This is the first report of CIRT followed by CIRT-irradiated bowel removal for an unresectable anastomosis recurrent lesion. Conclusions The clinical course of this case suggests that CIRT could be a potentially effective therapeutic option for LRRC involving the bowel, as long as the prophylactic removal of the irradiated bowel is performed at the optimal time. Further research involving larger sample sizes is warranted to validate the findings and conclusions of this case report.

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“…Late phase complications, such as spacer-related infection and gastrointestinal perforation, require removal of the ePTFE spacer. Shiba et al [29] reported ePTFE spacer-related infection, resulting in colon perforation that was observed 58 months after the initiation of PT, and they underwent surgical removal of the ePTFE spacer. We removed the ePTFE spacer in eight patients who experienced severe late-phase complications.…”

Section: Discussionmentioning

confidence: 99%

Clinical impact of spacer placement surgery with expanded polytetrafluoroethylene sheet for particle therapy

Fujinaka,

Komatsu,

Terashima

et al. 2023

Preprint

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Background: Spacer placement surgery is useful in particle therapy (PT) for patients with abdominopelvic malignant tumors located adjacent to the gastrointestinal tract. This study aimed to assess the safety, efficacy, and long-term outcomes of spacer placement surgery using an expanded polytetrafluoroethylene (ePTFE) spacer. Methods: This study included 131 patients who underwent ePTFE spacer placement surgery and subsequent PT between September 2006 and June 2019. The overall survival (OS) and local control (LC) rates were calculated using Kaplan-Meier method. Spacer-related complications were classified according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0). Results: The median follow-up period after spacer placement surgery was 36.8 months. The 3-year estimated OS and LC rates were 60.5% and 76.5%, respectively. A total of 130 patients (99.2%) were able to complete PT. Spacer-related complications of ≥ grade 3 were observed in four patients (3.1%) in the acute phase and 13 patients (9.9%) in the late phase. Ten patients (7.6%) required removal of the ePTFE spacer. Conclusions: Spacer placement surgery using an ePTFE spacer for abdominopelvic malignant tumors is technically feasible and acceptable for subsequent PT. However, severe spacer-related late complications were observed in some patients. Since long-term placement of a non-absorbable ePTFE spacer is associated with risks for morbidity and infection, careful long-term follow-up and prompt therapeutic intervention are essential when complications associated with the ePTFE spacer occur. Trial registration: retrospectively registered

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Safety and Efficacy of Re-irradiation With Carbon-ion Radiotherapy for Pelvic Recurrence of Rectal Cancer After Preoperative Chemoradiotherapy: A Retrospective Analysis

Cited by 9 publications

References 28 publications

Proton beam reirradiation for locally recurrent rectal cancer patients with prior pelvic irradiation

Proton beam reirradiation for locally recurrent rectal cancer patients with prior pelvic irradiation

Multidisciplinary management of locally recurrent rectal cancer with carbon ion radiotherapy followed by prophylactic removal of the irradiated bowel: a case report

Clinical impact of spacer placement surgery with expanded polytetrafluoroethylene sheet for particle therapy

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