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Hyperfractionated accelerated radiotherapy for rectal cancer in patients with prior pelvic irradiation. Int J Radiat Oncol Biol Phys 2010 May 01;77(1):60-5

Date

08/22/2009

Pubmed ID

19695792

DOI

10.1016/j.ijrobp.2009.04.056

Scopus ID

2-s2.0-77950567352   81 Citations

Abstract

PURPOSE: To retrospectively determine rates of toxicity, freedom from local progression, and survival in rectal cancer patients treated with reirradiation.

METHODS AND MATERIALS: Between February 2001 and February 2005, 50 patients with a history of pelvic radiotherapy were treated with hyperfractionated accelerated radiotherapy for primary (n = 2 patients) or recurrent (n = 48 patients) rectal adenocarcinoma. Patients were treated with 150-cGy fractions twice daily, with a total dose of 39 Gy (n = 47 patients) if the retreatment interval was >or=1 year or 30 Gy (n = 3) if the retreatment interval was <1 year. Concurrent chemotherapy was administered to 48 (96%) patients. Eighteen (36%) patients underwent surgical resection following radiotherapy.

RESULTS: Two patients had grade 3 acute toxicity and 13 patients had grade 3 to 4 late toxicity. The 3-year rate of grade 3 to 4 late toxicity was 35%. The 3-year rate of freedom from local progression was 33%. The 3-year freedom from local progression rate was 47% in patients undergoing surgery and 21% in those not undergoing surgery (p = 0.057). The 3-year overall survival rate was 39%. The 3-year overall survival rate was 66% in patients undergoing surgery and 27% in those not undergoing surgery (p = 0.003). The 3-year overall survival rate was 53% in patients with a retreatment interval of >2 years and 21% in those with a retreatment interval of <or=2 years (p = 0.001).

CONCLUSIONS: Hyperfractionated, accelerated reirradiation was well tolerated, with low rates of acute toxicity and moderate rates of late toxicity. Reirradiation may help improve pelvic control in rectal cancer patients with a history of pelvic radiotherapy.

Author List

Das P, Delclos ME, Skibber JM, Rodriguez-Bigas MA, Feig BW, Chang GJ, Eng C, Bedi M, Krishnan S, Crane CH

Author

Manpreet Bedi MD, MS Associate Professor in the Radiation Oncology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Antineoplastic Agents
Capecitabine
Combined Modality Therapy
Deoxycytidine
Disease-Free Survival
Female
Fluorouracil
Humans
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local
Organoplatinum Compounds
Pelvis
Pyridines
Radiation Injuries
Rectal Neoplasms
Retreatment
Retrospective Studies
Survival Rate
Tumor Burden