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DOI QR Code

Radiotherapy for locally recurrent rectal cancer treated with surgery alone as the initial treatment

  • Received : 2016.11.01
  • Accepted : 2017.02.07
  • Published : 2017.03.31

Abstract

Purpose: Although the technical developments of radiotherapy have been remarkable, there are currently few reports on the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as initial treatment in this three-dimensional conformal radiotherapy era. Thus, we retrospectively evaluated the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as the initial treatment. Materials and Methods: Thirty-two patients who underwent radiotherapy were enrolled in this study. The dose per fraction was 2.0-3.5 Gy. Because the treatment schedule was variable, the biological effective dose (BED) was calculated. Results: Local control (LC) and overall survival (OS) rates from the completion of radiotherapy were calculated. The 1-, 2-, 3-, 4-, and 5-year LC rates were 51.5%, 24.5%, 19.6%, 19.6%, and 13.1%, respectively. LC rates were significantly higher for the high BED group (${\geq}75Gy_{10}$) than for the lower BED group (<$75Gy_{10}$). All patients who reported pain achieved pain relief. The duration of pain relief was significantly higher for the high BED group than for the lower BED group. The 1-, 2-, 3-, 4-, and 5-year OS rates were 82.6%, 56.5%, 45.2%, 38.7%, and 23.2%, respectively. There was a trend toward higher OS rates in with higher BED group compared to lower BED group. Conclusion: For patients with unresectable locally recurrent rectal cancer treated with surgery alone, radiotherapy is effective treatment. The prescribed BED should be more than $75Gy_{10}$, if the dose to the organ at risk is within acceptable levels.

References

  1. Davies M, Harris D, Hirst G, et al. Local recurrence after abdomino-perineal resection. Colorectal Dis 2009;11:39-43. https://doi.org/10.1111/j.1463-1318.2008.01520.x
  2. Heriot AG, Byrne CM, Lee P, et al. Extended radical resection: the choice for locally recurrent rectal cancer. Dis Colon Rectum 2008;51:284-91. https://doi.org/10.1007/s10350-007-9152-9
  3. Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 2001;358:1291-304. https://doi.org/10.1016/S0140-6736(01)06409-1
  4. Mohiuddin M, Marks GM, Lingareddy V, Marks J. Curative surgical resection following reirradiation for recurrent rectal cancer. Int J Radiat Oncol Biol Phys 1997;39:643-9. https://doi.org/10.1016/S0360-3016(97)00340-4
  5. Wanebo HJ, Antoniuk P, Koness RJ, et al. Pelvic resection of recurrent rectal cancer: technical considerations and outcomes. Dis Colon Rectum 1999;42:1438-48. https://doi.org/10.1007/BF02235044
  6. Das P, Delclos ME, Skibber JM, et al. Hyperfractionated accelerated radiotherapy for rectal cancer in patients with prior pelvic irradiation. Int J Radiat Oncol Biol Phys 2010;77:60-5. https://doi.org/10.1016/j.ijrobp.2009.04.056
  7. Bosman SJ, Holman FA, Nieuwenhuijzen GA, Martijn H, Creemers GJ, Rutten HJ. Feasibility of reirradiation in the treatment of locally recurrent rectal cancer. Br J Surg 2014;101:1280-9. https://doi.org/10.1002/bjs.9569
  8. Tanis PJ, Doeksen A, van Lanschot JJ. Intentionally curative treatment of locally recurrent rectal cancer: a systematic review. Can J Surg 2013;56:135-44. https://doi.org/10.1503/cjs.025911
  9. Beyond TME Collaborative. Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg 2013;100:1009-14. https://doi.org/10.1002/bjs.9192
  10. Knol HP, Hanssens PE, Rutten HJ, Wiggers T. Effect of radiation therapy alone or in combination with surgery and/or chemotherapy on tumor and symptom control of recurrent rectal cancer. Strahlenther Onkol 1997;173:43-9. https://doi.org/10.1007/BF03039193
  11. Ciatto S, Pacini P. Radiation therapy of recurrences of carcinoma of the rectum and sigmoid after surgery. Acta Radiol Oncol 1982;21:105-9. https://doi.org/10.3109/02841868209133991
  12. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355:1114-23. https://doi.org/10.1056/NEJMoa060829
  13. Gerard JP, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24:4620-5. https://doi.org/10.1200/JCO.2006.06.7629
  14. Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991;324:709-15. https://doi.org/10.1056/NEJM199103143241101
  15. Yeo HL, Paty PB. Management of recurrent rectal cancer: practical insights in planning and surgical intervention. J Surg Oncol 2014;109:47-52. https://doi.org/10.1002/jso.23457
  16. O'Connell MJ, Childs DS, Moertel CG, et al. A prospective controlled evaluation of combined pelvic radiotherapy and methanol extraction residue of BCG (MER) for locally unresectable or recurrent rectal carcinoma. Int J Radiat Oncol Biol Phys 1982;8:1115-9. https://doi.org/10.1016/0360-3016(82)90057-8
  17. Frykholm GJ, Pahlman L, Glimelius B. Treatment of local recurrences of rectal carcinoma. Radiother Oncol 1995;34:185-94. https://doi.org/10.1016/0167-8140(95)01519-M
  18. Cameron MG, Kersten C, Vistad I, Fossa S, Guren MG. Palliative pelvic radiotherapy of symptomatic incurable rectal cancer: a systematic review. Acta Oncol 2014;53:164-73. https://doi.org/10.3109/0284186X.2013.837582
  19. Yamada S, Shinoto M, Shigeo Y, et al. Current status and perspective of heavy ion beam therapy for patients with pelvic recurrence after primarily resected rectal cancer. Gan To Kagaku Ryoho 2009;36:1263-6.