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Ritter AR, Miller ED. Intraoperative Radiation Therapy for Gastrointestinal Malignancies. Surg Oncol Clin N Am 2023; 32:537-552. [PMID: 37182991 DOI: 10.1016/j.soc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Despite improvements in definitive therapy, many patients with gastrointestinal malignancies experience local recurrences or have unresectable disease making subsequent management often challenging and morbid. Although higher doses of radiation may offer improved local control, the ability for dose escalation of external beam radiation therapy is often limited by adjacent radiosensitive structures. Intraoperative radiation therapy allows for additional radiotherapy to be delivered directly to the tumor or areas at highest risk for local recurrence while minimizing toxicity to adjacent structures, offering potentially improved outcomes for patients with unresectable disease or those with a high risk of local recurrence.
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Rokan Z, Simillis C, Kontovounisios C, Moran B, Tekkis P, Brown G. Locally Recurrent Rectal Cancer According to a Standardized MRI Classification System: A Systematic Review of the Literature. J Clin Med 2022; 11:jcm11123511. [PMID: 35743581 PMCID: PMC9224654 DOI: 10.3390/jcm11123511] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
(1) Background: The classification of locally recurrent rectal cancer (LRRC) is not currently standardized. The aim of this review was to evaluate pelvic LRRC according to the Beyond TME (BTME) classification system and to consider commonly associated primary tumour characteristics. (2) Methods: A systematic review of the literature prior to April 2020 was performed through electronic searches of the Science Citation Index Expanded, EMBASE, MEDLINE, and CENTRAL databases. The primary outcome was to assess the location and frequency of previously classified pelvic LRRC and translate this information into the BTME system. Secondary outcomes were assessing primary tumour characteristics. (3) Results: A total of 58 eligible studies classified 4558 sites of LRRC, most commonly found in the central compartment (18%), following anterior resection (44%), in patients with an 'advanced' primary tumour (63%) and following neoadjuvant radiotherapy (29%). Most patients also classified had a low rectal primary tumour. The lymph node status of the primary tumour leading to LRRC was comparable, with 52% node positive versus 48% node negative tumours. (4) Conclusions: This review evaluates the largest number of LRRCs to date using a single classification system. It has also highlighted the need for standardized reporting in order to optimise perioperative treatment planning.
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Affiliation(s)
- Zena Rokan
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK; (C.S.); (P.T.); (G.B.)
- Pelican Cancer Foundation, Basingstoke RG24 9NN, UK;
- Correspondence: (Z.R.); (C.K.)
| | - Constantinos Simillis
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK; (C.S.); (P.T.); (G.B.)
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge CB2 0QQ, UK
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK; (C.S.); (P.T.); (G.B.)
- Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
- Chelsea & Westminster Hospital, London SW10 9NH, UK
- Correspondence: (Z.R.); (C.K.)
| | - Brendan Moran
- Pelican Cancer Foundation, Basingstoke RG24 9NN, UK;
- Basingstoke & North Hampshire Hospital, Basingstoke RG24 9NA, UK
| | - Paris Tekkis
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK; (C.S.); (P.T.); (G.B.)
- Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Gina Brown
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK; (C.S.); (P.T.); (G.B.)
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3
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Fadel MG, Ahmed M, Malietzis G, Pellino G, Rasheed S, Brown G, Tekkis P, Kontovounisios C. Oncological outcomes of multimodality treatment for patients undergoing surgery for locally recurrent rectal cancer: A systematic review. Cancer Treat Rev 2022; 109:102419. [PMID: 35714574 DOI: 10.1016/j.ctrv.2022.102419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/01/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are several strategies in the management of locally recurrent rectal cancer (LRRC) with the optimum treatment yet to be established. This systematic review aims to compare oncological outcomes in patients undergoing surgery for LRRC who underwent neoadjuvant radiotherapy or chemoradiotherapy (CRT), adjuvant CRT, surgery only or surgery and intraoperative radiotherapy (IORT). METHODS A literature search of MEDLINE, EMBASE and CINAHL was performed for studies that reported data on oncological outcomes for the different treatment modalities in patients with LRRC from January 1990 to January 2022. Weighted means were calculated for the following outcomes: postoperative resection status, local control, and overall survival at 3 and 5 years. RESULTS Fifteen studies of 974 patients were included and they received the following treatment: 346 neoadjuvant radiotherapy, 279 neoadjuvant CRT, 136 adjuvant CRT, 189 surgery only, and 24 surgery and IORT. The highest proportion of R0 resection was found in the neoadjuvant CRT group followed by neoadjuvant radiotherapy and adjuvant CRT groups (64.07% vs 52.46% vs 47.0% respectively). The neoadjuvant CRT group had the highest mean 5-year local control rate (49.50%) followed by neoadjuvant radiotherapy (22.0%). Regarding the 5-year overall survival rate, the neoadjuvant CRT group had the highest mean of 34.92%, followed by surgery only (29.74%), neoadjuvant radiotherapy (28.94%) and adjuvant CRT (20.67%). CONCLUSIONS The findings of this systematic review suggest that neoadjuvant CRT followed by surgery can lead to improved resection status, long-term disease control and survival in the management of LRRC. However, treatment strategies in LRRC are complex and further comparisons, particularly taking into account previous treatments for the primary rectal cancer, are required.
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Affiliation(s)
- Michael G Fadel
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK; Department of Surgery and Cancer, Imperial College, London, UK.
| | - Mosab Ahmed
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - George Malietzis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK; Department of Surgery and Cancer, Imperial College, London, UK; Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy; Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Shahnawaz Rasheed
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK; Department of Surgery and Cancer, Imperial College, London, UK; Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Gina Brown
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Paris Tekkis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK; Department of Surgery and Cancer, Imperial College, London, UK; Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK; Department of Surgery and Cancer, Imperial College, London, UK; Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
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4
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Wang J, Prabhakaran S, Larach T, Warrier SK, Bednarski BK, Ngan SY, Leong T, Rodriguez-Bigas M, Peacock O, Chang G, Heriot AG, Kong JCH. Treatment strategies for locally recurrent rectal cancer. Eur J Surg Oncol 2022; 48:2292-2298. [DOI: 10.1016/j.ejso.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022] Open
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5
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Rokan Z, Simillis C, Kontovounisios C, Moran BJ, Tekkis P, Brown G. Systematic review of classification systems for locally recurrent rectal cancer. BJS Open 2021; 5:6272170. [PMID: 33963369 PMCID: PMC8105621 DOI: 10.1093/bjsopen/zrab024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/13/2021] [Indexed: 01/08/2023] Open
Abstract
Background Classification of pelvic local recurrence (LR) after surgery for primary rectal cancer is not currently standardized and optimal imaging is required to categorize anatomical site and plan treatment in patients with LR. The aim of this review was to evaluate the systems used to classify locally recurrent rectal cancer (LRRC) and the relevant published outcomes. Methods A systematic review of the literature prior to April 2020 was performed through electronic searches of the Science Citation Index Expanded, EMBASE, MEDLINE and CENTRAL databases. The primary outcome was to review the classifications currently in use; the secondary outcome was the extraction of relevant information provided by these classification systems including prognosis, anatomy and prediction of R0 after surgery. Results A total of 21 out of 58 eligible studies, classifying LR in 2086 patients, were reviewed. Studies used at least one of the following eight classification systems proposed by institutions or institutional groups (Mayo Clinic, Memorial Sloan-Kettering – original and modified, Royal Marsden and Leeds) or authors (Yamada, Hruby and Kusters). Negative survival outcomes were associated with increased pelvic fixity, associated symptoms of LR, lateral compared with central LR and involvement of three or more pelvic compartments. A total of seven studies used MRI with specifically defined anatomical compartments to classify LR. Conclusion This review highlights the various imaging systems in use to classify LRRC and some of the prognostic indicators for survival and oncological clearance based on these systems. Implementation of an agreed classification system to document pelvic LR consistently should provide more detailed information on anatomical site of recurrence, burden of disease and standards for comparative outcome assessment.
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Affiliation(s)
- Z Rokan
- Department of Radiology, Royal Marsden Hospital, London, UK.,Pelican Cancer Foundation, Basingstoke, UK.,Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge, UK
| | - C Simillis
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge, UK.,Department of Surgery & Cancer, Imperial College, London, UK
| | - C Kontovounisios
- Department of Surgery & Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK.,Department of Colorectal Surgery, Chelsea & Westminster Hospital, London, UK
| | - B J Moran
- Pelican Cancer Foundation, Basingstoke, UK.,Department of Peritoneal Malignancy, Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | - P Tekkis
- Department of Surgery & Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK.,Department of Colorectal Surgery, Chelsea & Westminster Hospital, London, UK
| | - G Brown
- Department of Radiology, Royal Marsden Hospital, London, UK.,Department of Surgery & Cancer, Imperial College, London, UK
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Tselis N, Arnold C, Martin D, Rödel C. Neoadjuvante Radio(chemo)therapie beim Rektumkarzinomrezidiv. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00494-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kadota T, Tsukada Y, Ito M, Katayama H, Mizusawa J, Nakamura N, Ito Y, Bando H, Ando M, Onaya H, Fukuda H, Kanemitsu Y. A phase III randomized controlled trial comparing surgery plus adjuvant chemotherapy with preoperative chemoradiotherapy followed by surgery plus adjuvant chemotherapy for locally recurrent rectal cancer: Japan Clinical Oncology Group study JCOG1801 (RC-SURVIVE study). Jpn J Clin Oncol 2020; 50:953-957. [PMID: 32409830 DOI: 10.1093/jjco/hyaa058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/13/2020] [Indexed: 01/30/2023] Open
Abstract
A randomized phase III trial was initiated in Japan in August 2019 to confirm the superiority of preoperative chemoradiotherapy followed by surgery plus adjuvant chemotherapy compared to the standard treatment, i.e. surgery plus adjuvant chemotherapy, for locally recurrent rectal cancer in local relapse-free survival. In all, 110 patients from 43 Japanese institutions will be recruited over a period of 6 years. Eligible patients would be registered and randomly assigned to each group with an allocation ratio of 1:1. The primary endpoint is local relapse-free survival. The secondary endpoints are overall survival, relapse-free survival, proportion of local relapse, proportion of distant relapse, proportion of patients with pathological R0 resection, response rate of preoperative chemoradiotherapy (preoperative chemoradiotherapy arm), pathological complete response rate (preoperative chemoradiotherapy arm), proportion of patients who completed the protocol treatment, incidence of adverse events (adverse reactions) and quality of life after surgery. This trial has been registered at the Japan Registry of Clinical Trial: jRCTs031190076 [https://jrct.niph.go.jp/latest-detail/jRCTs031190076] and ClinicalTrials.gov: NCT04288999 [https://clinicaltrials.gov/ct2/show/NCT04288999].
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Affiliation(s)
- Tomohiro Kadota
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Junki Mizusawa
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Naoki Nakamura
- Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Hideaki Bando
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hiroaki Onaya
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Haruhiko Fukuda
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
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8
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The use of intraoperative radiation therapy in the management of locally recurrent rectal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2020.100763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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9
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Joechle K, Gkika E, Grosu AL, Lang SA, Fichtner-Feigl S. Intraoperative Strahlentherapie – Indikationen und Optionen in der Viszeralchirurgie. Chirurg 2020; 91:743-754. [DOI: 10.1007/s00104-020-01179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Zusammenfassung
Hintergrund
Die intraoperative Strahlentherapie (IORT) ermöglicht durch die chirurgische Exposition des Tumors und des Tumorbetts eine hohe Präzision, welche eine hohe Strahlendosis im Bereich des Tumors zulässt und gleichzeitig gesundes Gewebe als den dosislimitierenden Faktor vor Strahlung schützt. Aus diesem Grund bietet die IORT besonders dann einen Vorteil, wenn die lokale Tumorkontrolle das Langzeitüberleben entscheidend beeinflusst und Funktionserhalt ermöglicht.
Ziel der Arbeit
Die in dieser Übersichtsarbeit aufgearbeiteten Erkenntnisse aus der Literaturrecherche erlauben einen evidenzbasierten Umgang hinsichtlich Indikationen und Therapieoptionen der IORT für intraabdominelle Tumoren.
Ergebnisse und Schlussfolgerung
Die Effektivität der IORT kann anhand der vorhandenen Evidenzlage nicht abschließend beurteilt werden, jedoch ist die IORT als Ergänzung der multimodalen Therapie bei (Rezidiv‑)Rektumkarzinomen und Sarkomen aktiv im klinischen Alltag etabliert. Magen- und Pankreaskarzinome stellen weitere Indikationen dar; ergänzende Studien sind jedoch notwendig, um die Rolle der IORT hier klar zu definieren. Ein wesentlicher Faktor, damit für Patienten mit primärem Karzinom und insbesondere für Patienten mit lokalem Rezidiv verbesserte lokale Rezidiv- und Überlebensraten erreicht werden können, scheint die Patientenselektion zu sein.
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10
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Local Therapy Options for Recurrent Rectal and Anal Cancer: Current Strategies and New Directions. CURRENT COLORECTAL CANCER REPORTS 2019. [DOI: 10.1007/s11888-019-00445-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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11
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Baghani HR, Robatjazi M, Mahdavi SR, Hosseini Aghdam SR. Evaluating the performance characteristics of some ion chamber dosimeters in high dose per pulse intraoperative electron beam radiation therapy. Phys Med 2019; 58:81-89. [DOI: 10.1016/j.ejmp.2019.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022] Open
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12
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Jensen G, Tao R, Eng C, Skibber JM, Rodriguez-Bigas M, Chang GJ, You YN, Bednarski BK, Minsky BD, Koay E, Taniguchi C, Krishnan S, Das P. Treatment of primary rectal adenocarcinoma after prior pelvic radiation: The role of hyperfractionated accelerated reirradiation. Adv Radiat Oncol 2018; 3:595-600. [PMID: 30370360 PMCID: PMC6200883 DOI: 10.1016/j.adro.2018.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose Previous studies have reported that hyperfractionated accelerated reirradiation can be used as part of multimodality treatment of locally recurrent rectal cancer with acceptable toxicity and promising outcomes. The purpose of this study was to evaluate the outcomes and toxicity of hyperfractionated accelerated reirradiation for patients with primary rectal adenocarcinoma and a history of prior pelvic radiation for other primary malignancies. Methods and materials We identified 10 patients with a prior history of pelvic radiation for other primary malignancies who were treated with hyperfractionated accelerated reirradiation for primary rectal adenocarcinoma. Radiation therapy was administered with 1.5 Gy twice daily fractions to a total dose of 39 Gy to 45Gy. Results The median follow-up time was 3.2 years (range, 0.6-9.0 years). Seven of 10 patients received surgery after reirradiation. The 3-year freedom-from-local-progression rate was 62% for all patients and 80% for patients who underwent surgery. The 3-year overall survival rate was 100%, with 3 deaths occurring at 4.7, 6.5, and 9.0 years after reirradiation. One patient had an acute Grade 3 toxicity of diarrhea, and 1 patient experienced a late Grade 3 toxicity of sacral insufficiency fracture. Conclusions Hyperfractionated accelerated reirradiation was well tolerated with promising rates of freedom from local progression and overall survival in patients with primary rectal cancer with a history of prior pelvic radiation therapy. This approach, along with concurrent chemotherapy and surgery, appears to be a viable treatment strategy for this patient population.
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Affiliation(s)
- Garrett Jensen
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Randa Tao
- Department of Radiation Oncology, The University of Utah, Salt Lake City, Utah
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - John M Skibber
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Miguel Rodriguez-Bigas
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - George J Chang
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Brian K Bednarski
- Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Eugene Koay
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Cullen Taniguchi
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Sunil Krishnan
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
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External Beam Re-irradiation in Rectal Cancer. Clin Oncol (R Coll Radiol) 2018; 30:116-123. [DOI: 10.1016/j.clon.2017.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/17/2017] [Accepted: 11/17/2017] [Indexed: 01/15/2023]
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Pilar A, Gupta M, Ghosh Laskar S, Laskar S. Intraoperative radiotherapy: review of techniques and results. Ecancermedicalscience 2017; 11:750. [PMID: 28717396 PMCID: PMC5493441 DOI: 10.3332/ecancer.2017.750] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Indexed: 12/14/2022] Open
Abstract
Intraoperative radiotherapy (IORT) is a technique that involves precise delivery of a large dose of ionising radiation to the tumour or tumour bed during surgery. Direct visualisation of the tumour bed and ability to space out the normal tissues from the tumour bed allows maximisation of the dose to the tumour while minimising the dose to normal tissues. This results in an improved therapeutic ratio with IORT. Although it was introduced in the 1960s, it has seen a resurgence of popularity with the introduction of self-shielding mobile linear accelerators and low-kV IORT devices, which by eliminating the logistical issues of transport of the patient during surgery for radiotherapy or building a shielded operating room, has enabled its wider use in the community. Electrons, low-kV X-rays and HDR brachytherapy are all different methods of IORT in current clinical use. Each method has its own unique set of advantages and disadvantages, its own set of indications where one may be better suited than the other, and each requires a specific kind of expertise. IORT has demonstrated its efficacy in a wide variety of intra-abdominal tumours, recurrent colorectal cancers, recurrent gynaecological cancers, and soft-tissue tumours. Recently, it has emerged as an attractive treatment option for selected, early-stage breast cancer, owing to the ability to complete the entire course of radiotherapy during surgery. IORT has been used in a multitude of roles across these sites, for dose escalation (retroperitoneal sarcoma), EBRT dose de-escalation (paediatric tumours), as sole radiation modality (early breast cancers) and as a re-irradiation modality (recurrent rectal and gynaecological cancers). This article aims to provide a review of the rationale, techniques, and outcomes for IORT across different sites relevant to current clinical practice.
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Affiliation(s)
- Avinash Pilar
- Department of Radiation Oncology, Tata Memorial Hospital, Dr Ernest Borges' Marg, Parel, Mumbai, MS, India 400012
| | - Meetakshi Gupta
- Department of Radiation Oncology, Tata Memorial Hospital, Dr Ernest Borges' Marg, Parel, Mumbai, MS, India 400012
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Dr Ernest Borges' Marg, Parel, Mumbai, MS, India 400012
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Dr Ernest Borges' Marg, Parel, Mumbai, MS, India 400012
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Kishan AU, Voog JC, Wiseman J, Cook RR, Ancukiewicz M, Lee P, Ryan DP, Clark JW, Berger DL, Cusack JC, Wo JY, Hong TS. Standard fractionation external beam radiotherapy with and without intraoperative radiotherapy for locally recurrent rectal cancer: the role of local therapy in patients with a high competing risk of death from distant disease. Br J Radiol 2017; 90:20170134. [PMID: 28613934 DOI: 10.1259/bjr.20170134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE We sought to evaluate the effectiveness and safety of utilizing radiotherapy (RT) with standard fractionation, with or without intraoperative RT (IORT), to treat locally recurrent rectal cancer (LRRC). METHODS Retrospective review of 25 patients with LRRC treated with standard fractionation RT from 2005 to 2011. 15 patients (60%) had prior pelvic RT and 10 (40%) had synchronous metastases. The median equivalent dose in 2-Gy fractions was 30 and 49.6 Gy in patients with and without prior RT, respectively. 23 patients (92%) received concurrent chemotherapy and 16 (64%) underwent surgical resection. Eight patients (33.3%, four with and four without prior RT) received IORT. A competing risks model was developed to estimate the cumulative incidence of local failure with death treated as a competing event. RESULTS Median follow-up was 36.9 months after the date of local recurrence. 3-year rates of overall survival (OS), local control (LC) and death with LC were 51.6%, 73.3% and 69.2%, respectively. On multivariable analysis, surgical resection was significantly predictive of improved OS (p < 0.05). If surgical resection were removed from the multivariable model, given the collinearity between IORT delivery and surgical resection, then IORT also became a significant predictor of OS (p < 0.05). Systemic disease at the time of local recurrence was not associated with either LC or OS. No patient had grade ≥3 acute or late toxicity. CONCLUSION RT with standard fractionation is safe and effective in the treatment of patients with LRRC, even in patients with significant risk of systemic disease and/or history of prior RT. Advances in knowledge: The utility of RT with standard fractionation, generally with chemotherapy, in the treatment of LRRC is demonstrated. In this high-risk cohort of patients with a 40% incidence of synchronous metastatic disease, surgical resection of the recurrence was the major predictor of OS, though a benefit to IORT was also suggested. No patients had grade ≥3 acute or late toxicity, though 40% had undergone prior RT, underscoring the tolerability of standard fractionation RT in this setting.
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Affiliation(s)
- Amar U Kishan
- 1 Department of Radiation Oncology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Justin C Voog
- 2 Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | - Ryan R Cook
- 1 Department of Radiation Oncology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Marek Ancukiewicz
- 2 Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Percy Lee
- 1 Department of Radiation Oncology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - David P Ryan
- 4 Department of Medical Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey W Clark
- 5 Division of General and Gastrointestinal Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - David L Berger
- 5 Division of General and Gastrointestinal Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - James C Cusack
- 6 Division of Surgical Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Y Wo
- 2 Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Theodore S Hong
- 2 Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Ferrari M, Travaini LL, Ciardo D, Garibaldi C, Gilardi L, Glynne-Jones R, Grana CM, Jereczek-Fossa BA, Marvaso G, Ronchi S, Leonardi MC, Orecchia R, Cremonesi M. Interim 18 FDG PET/CT during radiochemotherapy in the management of pelvic malignancies: A systematic review. Crit Rev Oncol Hematol 2017; 113:28-42. [DOI: 10.1016/j.critrevonc.2017.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/22/2016] [Accepted: 02/15/2017] [Indexed: 12/14/2022] Open
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Pelvic Reirradiation for the Treatment of Locally Recurrent Rectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0360-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Estimation of the risk of secondary malignancies following intraoral electron radiotherapy for tongue cancer patients. JOURNAL OF RADIOTHERAPY IN PRACTICE 2017. [DOI: 10.1017/s1460396916000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractPurposeTo measure dosimetric characteristics for linear accelerator-based electron beams, which are applied through locally manufactured acrylic tubes for intraoral radiotherapy and to calculate the secondary cancer risk for organs at risk.Materials and methodsSix different acrylic tubes were exposed to a 6-MeV electron beam; they had tips with three angles (0°, 15° and 30°) and two diameters (2·5 and 3·0 cm). Gafchromic EBT2 film was horizontally and vertically inserted in a solid water phantom to measure the dose profiles and percentage depth doses (PDDs). The measured data from radio-photoluminescence glass dosimeters placed on the neck and both eyes were used to estimate the lifetime attributable risk of secondary cancer resulting from intraoral radiotherapy for tongue cancer.ResultsA total of 12 dose profiles were obtained from six different acrylic applicators at 0·5 and 1·28 cm depths. Circular shapes were obtained from 0° applicators, and oval shapes were obtained from 15° and 30° applicators. Absorbed doses at a 0·5 cm depth were higher than those at a 1·28 cm depth. PDD shapes for the six acrylic applicators were similar to those of a normal 6 MeV electron beam. Larger-diameter applicators showed higher PDD than smaller-diameter applicators with the same tip angle. According to our secondary cancer risk estimation, if 100,000 patients received intraoral radiotherapy at 30 years and lived until 80 years, 122 female and 22 male patients would develop secondary thyroid cancer, while 13 female and 18 male patients would develop secondary ocular melanoma or retinoblastoma.ConclusionsDosimetric characteristics for linear accelerator-based intraoperative radiotherapy treatment beam were confirmed. In addition, we found that 0·1% of tongue cancer patients would get secondary malignancies for both eyes and thyroid from this treatment.
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Tao R, Tsai CJ, Jensen G, Eng C, Kopetz S, Overman MJ, Skibber JM, Rodriguez-Bigas M, Chang GJ, You YQN, Bednarski BK, Minsky BD, Delclos ME, Koay E, Krishnan S, Crane CH, Das P. Hyperfractionated accelerated reirradiation for rectal cancer: An analysis of outcomes and toxicity. Radiother Oncol 2017; 122:146-151. [PMID: 28057329 DOI: 10.1016/j.radonc.2016.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/28/2016] [Accepted: 12/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate outcomes and toxicity in patients treated with hyperfractionated pelvic reirradiation for recurrent rectal cancer. MATERIALS AND METHODS 102 patients with recurrent rectal adenocarcinoma were treated with pelvic reirradiation with a hyperfractionated accelerated approach, consisting of 1.5Gy twice daily fractions to a total dose of 30-45Gy (median 39Gy), with the most common total dose 39Gy (n=90, 88%). The median dose of prior pelvic radiation therapy (RT) was 50.4Gy (range: 25-63Gy). RESULTS The median follow-up was 40months for living patients (range, 3-150months). The 3-year freedom from local progression (FFLP) rate was 40% and the 3-year overall survival (OS) rate was 39%. Treatment with surgery was significantly associated with improved FFLP and OS, with 3-year FFLP rate of 49% vs. 30% (P=0.013), and 3-year OS rate of 62% vs. 20% (P<0.0001), compared to those without surgery. The actuarial 3-year rate of grade 3-4 late toxicity was 34%; patients who underwent surgery had a significantly higher rate of grade 3-4 late toxicity compared to those without surgery (54% vs. 16%, P=0.001). CONCLUSIONS This large, retrospective, single-institution study shows that hyperfractionated accelerated reirradiation was well tolerated. The rate of FFLP was promising, given that the study comprised heavily pre-treated patients with recurrences. Rates of FFLP and OS were particularly impressive in patients who underwent both reirradiation and surgery.
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Affiliation(s)
- Randa Tao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, USA.
| | - Chiaojung Jillian Tsai
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Garrett Jensen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - John M Skibber
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Miguel Rodriguez-Bigas
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - George J Chang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Yi-Qian Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Brian K Bednarski
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Marc E Delclos
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Eugene Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Christopher H Crane
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
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Holman FA, Bosman SJ, Haddock MG, Gunderson LL, Kusters M, Nieuwenhuijzen GAP, van den Berg H, Nelson H, Rutten HJ. Results of a pooled analysis of IOERT containing multimodality treatment for locally recurrent rectal cancer: Results of 565 patients of two major treatment centres. Eur J Surg Oncol 2016; 43:107-117. [PMID: 27659000 DOI: 10.1016/j.ejso.2016.08.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/13/2016] [Accepted: 08/09/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Aim of this study is analysing the pooled results of Intra-Operative Electron beam Radiotherapy (IOERT) containing multimodality treatment of locally recurrent rectal cancer (LRRC) of two major treatment centres. METHODS AND MATERIALS Five hundred sixty five patients with LRRC who underwent multimodality-treatment up to 2010 were studied. The preferred treatment was preoperative chemo-radiotherapy, surgery and IOERT. In uni- and multivariate analyses risk factors for local re-recurrence, distant metastasis free survival, relapse free survival, cancer-specific survival and overall survival were studied. RESULTS Two hundred fifty one patients (44%) underwent a radical (R0) resection. In patients who had no preoperative treatment the R0 resection rate was 26%, and this was 43% and 50% for patients who respectively received preoperative re-(chemo)-irradiation or full-course radiotherapy (p < 0.0001). After uni- and multivariate analysis it was found that all oncologic parameters were influenced by preoperative treatment and radicality of the resection. Patients who were re-irradiated had a similar outcome compared to patients, who were radiotherapy naive and could undergo full-course treatment, except the chance of local re-recurrence was higher for re-irradiated patients. Waiting-time between preoperative radiotherapy and IOERT was inversely correlated with the chance of local re-recurrence, and positively correlated with the chance of a R0 resection. CONCLUSIONS R0 resection is the most important factor influencing oncologic parameters in treatment of LRRC. Preoperative (chemo)-radiotherapy increases the chance of achieving radical resections and improves oncologic outcomes. Short waiting-times between preoperative treatment and IOERT improves the effectiveness of IOERT to reduce the chance of a local re-recurrence.
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Affiliation(s)
- F A Holman
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - S J Bosman
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - M G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - L L Gunderson
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - M Kusters
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - H van den Berg
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
| | - H Nelson
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - H J Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands; GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands.
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Guren MG, Undseth C, Rekstad BL, Brændengen M, Dueland S, Spindler KLG, Glynne-Jones R, Tveit KM. Reirradiation of locally recurrent rectal cancer: A systematic review. Radiother Oncol 2014; 113:151-7. [DOI: 10.1016/j.radonc.2014.11.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/10/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022]
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Intraoperative radiotherapy in colorectal cancer: systematic review and meta-analysis of techniques, long-term outcomes, and complications. Surg Oncol 2012; 22:22-35. [PMID: 23270946 DOI: 10.1016/j.suronc.2012.11.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/03/2012] [Accepted: 11/10/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The precise contribution of IORT to the management of locally advanced and recurrent colorectal cancer (CRC) remains uncertain. We performed a systematic review and meta-analysis to assess the value of IORT in this setting. METHODS Studies published between 1965 and 2011 that reported outcomes after IORT for advanced or recurrent CRC were identified by an electronic literature search. Studies were assessed for methodological quality and design, and evaluated for technique of IORT delivery, oncological outcomes, and complications following IORT. Outcomes were analysed with fixed-effect and random-effect model meta-analyses and heterogeneity and publication bias examined. RESULTS 29 studies comprising 14 prospective and 15 retrospective studies met the inclusion criteria and were assessed, yielding a total of 3003 patients. The indication for IORT was locally advanced disease in 1792 patients and locally recurrent disease in 1211 patients. Despite heterogeneity in methodology and reporting practice, IORT is principally applied for the treatment of close or positive margins. When comparative studies were evaluated, a significant effect favouring improved local control (OR 0.22; 95% CI = 0.05-0.86; p = 0.03), disease free survival (HR 0.51; 95% CI = 0.31-0.85; p = 0.009), and overall survival (HR 0.33; 95% CI = 0.2-0.54; p = 0.001) was noted with no increase in total (OR 1.13; 95% CI = 0.77-1.65; p = 0.57), urologic (OR 1.35; 95% CI = 0.84-2.82; p = 0.47), or anastomotic complications (OR 0.94; 95% CI = 0.42-2.1; p = 0.98). Increased wound complications were noted after IORT (OR 1.86; 95% CI = 1.03-3.38; p = 0.049). CONCLUSIONS Despite methodological weaknesses in the studies evaluated, our results suggest that IORT may improve oncological outcomes in advanced and recurrent CRC.
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Guo S, Reddy CA, Kolar M, Woody N, Mahadevan A, Deibel FC, Dietz DW, Remzi FH, Suh JH. Intraoperative radiation therapy with the photon radiosurgery system in locally advanced and recurrent rectal cancer: retrospective review of the Cleveland clinic experience. Radiat Oncol 2012; 7:110. [PMID: 22817880 PMCID: PMC3430560 DOI: 10.1186/1748-717x-7-110] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 07/20/2012] [Indexed: 12/13/2022] Open
Abstract
Background Patients with locally advanced or recurrent rectal cancer often require multimodality treatment. Intraoperative radiation therapy (IORT) is a focal approach which aims to improve local control. Methods We retrospectively reviewed 42 patients treated with IORT following definitive resection of a locally advanced or recurrent rectal cancer from 2000–2009. All patients were treated with the Intrabeam® Photon Radiosurgery System (PRS). A dose of 5 Gy was prescribed to a depth of 1 cm (surface dose range: 13.4-23.1, median: 14.4 Gy). Median survival times were calculated using Kaplan-Meier analysis. Results Of 42 patients, 32 had recurrent disease (76%) while 10 had locally advanced disease (24%). Eighteen patients (43%) had tumors fixed to the sidewall. Margins were positive in 19 patients (45%). Median follow-up after IORT was 22 months (range 0.2-101). Median survival time after IORT was 34 months. The 3-year overall survival rate was 49% (43% for recurrent and 65% for locally advanced patients). Local recurrence was evaluable in 34 patients, of whom 32% failed. The 1-year local recurrence rate was 16%. Distant metastasis was evaluable in 30 patients, of whom 60% failed. The 1-year distant metastasis rate was 32%. No intraoperative complications were attributed to IORT. Median duration of IORT was 35 minutes (range: 14–39). Median discharge time after surgery was 7 days (range: 2–59). Hydronephrosis after IORT occurred in 10 patients (24%), 7 of whom had documented concomitant disease recurrence. Conclusions The Intrabeam® PRS appears to be a safe technique for delivering IORT in rectal cancer patients. IORT with PRS marginally increased operative time, and did not appear to prolong hospitalization. Our rates of long-term toxicity, local recurrence, and survival rates compare favorably with published reports of IORT delivery with other methods.
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Affiliation(s)
- Susan Guo
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
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Abstract
Evidence of the clinical benefit of surgery or metastasectomy for metastatic colorectal cancer to disease sites including the liver, lung, peritoneum, and pelvis as a potentially curative option is now available in the literature. The oncologic outcome of this treatment strategy achieves 5-year survival ranging between 20% and 50%. These survival gains have not been previously observed in the management of metastatic colorectal cancer. Treatment of potential surgical candidates requires a combined modality approach with systemic therapies to achieve macroscopic tumor removal and microscopic targeting of tumor deposits to achieve disease control. In nonsurgical candidates, systemic therapy, radiation therapy, and interventional oncology procedures may potentially facilitate sufficient disease downstaging for surgery. The purpose of this article is to provide a comprehensive review of the therapeutic advances in the surgical management of metastatic colorectal cancer.
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Affiliation(s)
- Terence C Chua
- UNSW Department of Surgery, Hepatobiliary and Surgical Oncology Unit, St George Hospital, Sydney, Australia
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Wada H, Nemoto K, Nomiya T, Murakami M, Suzuki M, Kuroda Y, Ichikawa M, Ota I, Hagiwara Y, Ariga H, Takeda K, Takai K, Fujimoto K, Kenjo M, Ogawa K. A phase I trial of S-1 with concurrent radiotherapy in patients with locally recurrent rectal cancer. Int J Clin Oncol 2012; 18:273-8. [PMID: 22318782 DOI: 10.1007/s10147-012-0375-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 12/29/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND The purpose of this phase I trial of S-1 chemotherapy in combination with pelvic radiotherapy for locally recurrent rectal cancer was to determine the maximum tolerated dose (MTD), recommended dose (RD), and dose-limiting toxicity (DLT) of S-1. METHODS We enrolled 9 patients between April 2005 and March 2009. Radiotherapy (total dose, 60 Gy in 30 fractions) was given to the gross local recurrent tumor and pelvic nodal metastases using three-dimensional radiotherapy planning. We administered oral S-1 twice a day on days 1-14 and 22-35 during radiotherapy. The dose of S-1 was initially 60 mg/m(2)/day and was increased to determine the MTD and RD for this regimen. RESULTS DLT appeared at dose level 2 (70 mg/m(2)/day) in 2 patients, who experienced grade 3 enterocolitis and consequently required suspension of S-1 administration for longer than 2 weeks. Hematological toxicity was mild and reversible. At the initial evaluation, complete regression and partial regression were seen in 1 patient (11%) and 2 patients (22%), respectively. CONCLUSION This phase I trial of S-1 chemotherapy with pelvic radiotherapy for locally recurrent rectal cancer revealed that the MTD for S-1 was 70 mg/m(2)/day and the RD was 60 mg/m(2)/day.
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Affiliation(s)
- Hitoshi Wada
- Department of Radiation Oncology, Miyagi Cancer Center, Nodayama 47-1, Medeshima-shiote, Natori, 981-1293, Japan.
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Dewas S, Bibault JE, Mirabel X, Nickers P, Castelain B, Lacornerie T, Jarraya H, Lartigau E. Robotic image-guided reirradiation of lateral pelvic recurrences: preliminary results. Radiat Oncol 2011; 6:77. [PMID: 21699690 PMCID: PMC3141526 DOI: 10.1186/1748-717x-6-77] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 06/23/2011] [Indexed: 12/12/2022] Open
Abstract
Background The first-line treatment of a pelvic recurrence in a previously irradiated area is surgery. Unfortunately, few patients are deemed operable, often due to the location of the recurrence, usually too close to the iliac vessels, or the associated surgical morbidity. The objective of this study is to test the viability of robotic image-guided radiotherapy as an alternative treatment in inoperable cases. Methods Sixteen patients previously treated with radiotherapy were reirradiated with CyberKnife® for lateral pelvic lesions. Recurrences of primary rectal cancer (4 patients), anal canal (6), uterine cervix cancer (4), endometrial cancer (1), and bladder carcinoma (1) were treated. The median dose of the previous treatment was 45 Gy (EqD2 range: 20 to 96 Gy). A total dose of 36 Gy in six fractions was delivered with the CyberKnife over three weeks. The responses were evaluated according to RECIST criteria. Results Median follow-up was 10.6 months (1.9 to 20.5 months). The actuarial local control rate was 51.4% at one year. Median disease-free survival was 8.3 months after CyberKnife treatment. The actuarial one-year survival rate was 46%. Acute tolerance was limited to digestive grade 1 and 2 toxicities. Conclusions Robotic stereotactic radiotherapy can offer a short and well-tolerated treatment for lateral pelvic recurrences in previously irradiated areas in patients otherwise not treatable. Efficacy and toxicity need to be evaluated over the long term, but initial results are encouraging.
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Affiliation(s)
- Sylvain Dewas
- Département Universitaire de Radiothérapie, CyberKnife Nord-Ouest, Centre Oscar Lambret, CLCC, Université Lille II, Lille, France
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Dewas S, Bibault JE, Mirabel X, Nickers P, Castelain B, Lacornerie T, Jarraya H, Lartigau E. Robotic image-guided reirradiation of lateral pelvic recurrences: preliminary results. Radiat Oncol 2011. [PMID: 21699690 DOI: 10.1186/1748-717x-66-77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The first-line treatment of a pelvic recurrence in a previously irradiated area is surgery. Unfortunately, few patients are deemed operable, often due to the location of the recurrence, usually too close to the iliac vessels, or the associated surgical morbidity. The objective of this study is to test the viability of robotic image-guided radiotherapy as an alternative treatment in inoperable cases. METHODS Sixteen patients previously treated with radiotherapy were reirradiated with CyberKnife® for lateral pelvic lesions. Recurrences of primary rectal cancer (4 patients), anal canal (6), uterine cervix cancer (4), endometrial cancer (1), and bladder carcinoma (1) were treated. The median dose of the previous treatment was 45 Gy (EqD2 range: 20 to 96 Gy). A total dose of 36 Gy in six fractions was delivered with the CyberKnife over three weeks. The responses were evaluated according to RECIST criteria. RESULTS Median follow-up was 10.6 months (1.9 to 20.5 months). The actuarial local control rate was 51.4% at one year. Median disease-free survival was 8.3 months after CyberKnife treatment. The actuarial one-year survival rate was 46%. Acute tolerance was limited to digestive grade 1 and 2 toxicities. CONCLUSIONS Robotic stereotactic radiotherapy can offer a short and well-tolerated treatment for lateral pelvic recurrences in previously irradiated areas in patients otherwise not treatable. Efficacy and toxicity need to be evaluated over the long term, but initial results are encouraging.
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Affiliation(s)
- Sylvain Dewas
- Département Universitaire de Radiothérapie, CyberKnife Nord-Ouest, Centre Oscar Lambret, CLCC, Université Lille II, Lille, France
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Intra-operative radiotherapy of rectal cancer: results of the French multi-institutional randomized study. Radiother Oncol 2011; 98:298-303. [PMID: 21339010 DOI: 10.1016/j.radonc.2011.01.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 01/19/2011] [Accepted: 01/25/2011] [Indexed: 01/29/2023]
Abstract
PURPOSE To assess efficacy and tolerance of intra-operative radiation therapy (IORT) in patients suffering from locally advanced rectal cancer, treated with preoperative radiotherapy followed by surgical resection. METHODS AND MATERIALS In this French, multicenter, comparative, phase III study, 142 patients with locally advanced rectal cancer (T3 or T4 or N+, and M0), treated with a 4-week preoperative radiotherapy (40 grays) were randomly assigned to either surgical resection alone ( CONTROL GROUP n=69) or combined to 18-gray intra-operative radiation therapy (IORT group: n=73) between 1993 and 2001. RESULTS The 5-year cumulative incidence of local control was 91.8% with IORT and 92.8% with surgery alone (p=0.6018); the mean duration without local relapse (Kaplan-Meier method) was 107 versus 126 months, respectively. No statistically significant difference was demonstrated for overall survival (p=0.2578) disease-free survival (p=0.7808) and probability of metastatic relapse (p=0.6037) with 5-year cumulative incidences of 69.8% versus 74.8%, 63.7% versus 63.1%, and 26.1% versus 30.2%, respectively. 48 patients of the IORT group and 53 patients of the control group were alive with a median follow-up of 60.1 and 61.2 months, respectively. Post-operative complications were observed in the IORT group in 21 patients (29.6%) and in the control group in 13 patients (19.1%) (p=0.15), with an acceptable tolerance profile. CONCLUSIONS Although this randomized study did not demonstrate any significant improvement in local control and disease-free survival in rectal cancer patients treated with preoperative radiation therapy receiving IORT or not, it confirmed the technical feasibility and the necessity for evaluating IORT for rectal carcinoma in further clinical studies.
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Uemura M, Ikeda M, Yamamoto H, Kitani K, Tokuoka M, Matsuda K, Hata Y, Mizushima T, Takemasa I, Sekimoto M, Hosokawa K, Matsuura N, Doki Y, Mori M. Clinicopathological Assessment of Locally Recurrent Rectal Cancer and Relation to Local Re-Recurrence. Ann Surg Oncol 2010; 18:1015-22. [DOI: 10.1245/s10434-010-1435-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Indexed: 12/19/2022]
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Mobaraki A, Ohno T, Yamada S, Sakurai H, Nakano T. Cost-effectiveness of carbon ion radiation therapy for locally recurrent rectal cancer. Cancer Sci 2010; 101:1834-9. [PMID: 20500516 PMCID: PMC11159752 DOI: 10.1111/j.1349-7006.2010.01604.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to evaluate the cost-effectiveness of carbon ion radiotherapy compared with conventional multimodality therapy in the treatment of patients with locally recurrent rectal cancer. Direct costs for diagnosis, recurrent treatment, follow-up, visits, supportive therapy, complications, and admission were computed for each individual using a sample of 25 patients presenting with local recurrent rectal cancer at the National Institute of Radiological Science (NIRS) and Gunma University Hospital (GUH). Patients received only radical surgery for primary rectal adenocarcinoma and had isolated unresectable pelvic recurrence. Fourteen and 11 patients receiving treatment for the local recurrence between 2003 and 2005 were followed retrospectively at NIRS and GUH, respectively. Treatment was carried out with carbon ion radiotherapy (CIRT) alone at NIRS, while multimodality therapy including three-dimensional conformal radiotherapy, chemotherapy, and hyperthermia was performed at GUH. The 2-year overall survival rate was 85% and 55% for CIRT and multimodality treatment, respectively. The mean cost was yen4 803 946 for the CIRT group and yen4 611 100 for the multimodality treatment group. The incremental cost-effectiveness ratio for CIRT was yen6428 per 1% increase in survival. The median duration of total hospitalization was 37 days for CIRT and 66 days for the multimodality treatment group. In conclusion, by calculating all direct costs, CIRT was found to be a potential cost effective treatment modality as compared to multimodality treatment for locally recurrent rectal cancer.
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Affiliation(s)
- Abdulelah Mobaraki
- Department of Radiation Oncology, Graduate School of Medicine, Gunma University, Maebashi, Japan
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de Wilt JHW, Vermaas M, Ferenschild FTJ, Verhoef C. Management of locally advanced primary and recurrent rectal cancer. Clin Colon Rectal Surg 2010; 20:255-63. [PMID: 20011207 DOI: 10.1055/s-2007-984870] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Treatment for patients with locally advanced and recurrent rectal cancer differs significantly from patients with rectal cancer restricted to the mesorectum. Adequate preoperative imaging of the pelvis is therefore important to identify those patients who are candidates for multimodality treatment, including preoperative chemoradiation protocols, intraoperative radiotherapy, and extended surgical resections. Much effort should be made to select patients with these advanced tumors for treatment in specialized referral centers. This has been shown to reduce morbidity and mortality and improve long-term survival rates. In this article, we review the best treatment options for patients with locally advanced and recurrent rectal cancer. We also emphasize the necessity of a multidisciplinary team, including a radiologist, radiation oncologist, urologist, surgical oncologist, plastic surgeon, and gynecologist in the diagnosis and treatment of patients with these pelvic tumors.
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Affiliation(s)
- Johannes H W de Wilt
- Department of Surgical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
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Haddock MG, Miller RC, Nelson H, Pemberton JH, Dozois EJ, Alberts SR, Gunderson LL. Combined modality therapy including intraoperative electron irradiation for locally recurrent colorectal cancer. Int J Radiat Oncol Biol Phys 2010; 79:143-50. [PMID: 20395067 DOI: 10.1016/j.ijrobp.2009.10.046] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 10/26/2009] [Accepted: 10/29/2009] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate survival, relapse patterns, and prognostic factors in patients with colorectal cancer relapse treated with curative-intent therapy, including intraoperative electron radiation therapy (IOERT). METHODS AND MATERIALS From April 1981 through January 2008, 607 patients with recurrent colorectal cancer received IOERT as a component of treatment. IOERT was preceded or followed by external radiation (median dose, 45.5 Gy) in 583 patients (96%). Resection was classified as R0 in 227 (37%), R1 in 224 (37%), and R2 in 156 (26%). The median IOERT dose was 15 Gy (range, 7.5-30 Gy). RESULTS Median overall survival was 36 months. Five- and 10-year survival rates were 30% and 16%, respectively. Survival estimates at 5 years were 46%, 27%, and 16% for R0, R1, and R2 resection, respectively. Multivariate analysis revealed that R0 resection, no prior chemotherapy, and more recent treatment (in the second half of the series) were associated with improved survival. The 3-year cumulative incidence of central, local, and distant relapse was 12%, 23%, and 49%, respectively. Central and local relapse were more common in previously irradiated patients and in those with subtotal resection. Toxicity Grade 3 or higher partially attributable to IOERT was observed in 66 patients (11%). Neuropathy was observed in 94 patients (15%) and was more common with IOERT doses exceeding 12.5 Gy. CONCLUSIONS Long-term survival and disease control was achievable in patients with locally recurrent colorectal cancer. Continued evaluation of curative-intent, combined-modality therapy that includes IOERT is warranted in this high-risk population.
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Affiliation(s)
- Michael G Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
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Pacelli F, Tortorelli AP, Rosa F, Bossola M, Sanchez AM, Papa V, Valentini V, Doglietto GB. Locally Recurrent Rectal Cancer: Prognostic Factors and Long-Term Outcomes of Multimodal Therapy. Ann Surg Oncol 2010; 17:152-162. [DOI: 10.1245/s10434-009-0737-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Kim MS, Choi C, Yoo S, Cho C, Seo Y, Ji Y, Lee D, Hwang D, Moon S, Kim MS, Kang H. Stereotactic body radiation therapy in patients with pelvic recurrence from rectal carcinoma. Jpn J Clin Oncol 2008; 38:695-700. [PMID: 18723850 DOI: 10.1093/jjco/hyn083] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate the clinical applications of stereotactic body radiation therapy (SBRT) using the CyberKnife system for pelvic recurrence from rectal cancer with a focus on survival and toxicity. METHODS Between 2002 and 2006, 23 patients with recurrent rectal cancer were treated with SBRT at our institution. The median follow-up was 31 months. Sites of recurrence were pre-sacral in seven patients and the pelvic wall in 16. SBRT doses ranged from 30 to 51 Gy (median 39 Gy) and were delivered in three fractions. Response to treatment was assessed by computed tomography. Overall and local progression-free survival and toxicities were recorded. RESULTS Four-year overall survival and local control rates were 24.9 and 74.3%, respectively. No prognostic factor was found to affect patient survival or local progression. One patient developed a severe radiation-related toxicity, but recovered completely after treatment. CONCLUSIONS SBRT for pelvic recurrence was found to be comparable with other modalities with respect to overall survival and complication rates. Further studies are needed to confirm these preliminary results.
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Affiliation(s)
- Mi-Sook Kim
- Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Nowon-Gu, Seoul, Republic of Korea.
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Brændengen M, Tveit KM, Berglund Å, Birkemeyer E, Frykholm G, Påhlman L, Wiig JN, Byström P, Bujko K, Glimelius B. Randomized Phase III Study Comparing Preoperative Radiotherapy With Chemoradiotherapy in Nonresectable Rectal Cancer. J Clin Oncol 2008; 26:3687-94. [DOI: 10.1200/jco.2007.15.3858] [Citation(s) in RCA: 342] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposePreoperative chemoradiotherapy is considered standard treatment for locally advanced rectal cancer, although the scientific evidence for the chemotherapy addition is limited. This trial investigated whether chemotherapy as part of a multidisciplinary treatment approach would improve downstaging, survival, and relapse rate.Patients and MethodsThe randomized study included 207 patients with locally nonresectable T4 primary rectal carcinoma or local recurrence from rectal carcinoma in the period 1996 to 2003. The patients received either chemotherapy (fluorouracil/leucovorin) administered concurrently with radiotherapy (50 Gy) and adjuvant for 16 weeks after surgery (CRT group, n = 98) or radiotherapy alone (50 Gy; RT group, n = 109).ResultsThe two groups were well balanced according to pretreatment characteristics. An R0 resection was performed in 82 patients (84%) in the CRT group and in 74 patients (68%) in the RT group (P = .009). Pathologic complete response was seen in 16% and 7%, respectively. After an R0 + R1 resection, local recurrence was found in 5% and 7%, and distant metastases in 26% and 39%, respectively. Local control (82% v 67% at 5 years; log-rank P = .03), time to treatment failure (63% v 44%; P = .003), cancer-specific survival (72% v 55%; P = .02), and overall survival (66% v 53%; P = .09) all favored the CRT group. Grade 3 or 4 toxicity, mainly GI, was seen in 28 (29%) of 98 and six (6%) of 109, respectively (P = .001). There was no difference in late toxicity.ConclusionCRT improved local control, time to treatment failure, and cancer-specific survival compared with RT alone in patients with nonresectable rectal cancer. The treatments were well tolerated.
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Affiliation(s)
- Morten Brændengen
- From the Departments of Medical Oncology and Surgery, Norwegian Radium Hospital; Ullevål University Hospital, Cancer Centre, Oslo, Norway; University of Oslo, Oslo; Division of Hematology and Oncology, Stavanger University Hospital, Stavanger; Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology, Radiology, and Clinical Immunology, University of Uppsala; Department of
| | - Kjell M. Tveit
- From the Departments of Medical Oncology and Surgery, Norwegian Radium Hospital; Ullevål University Hospital, Cancer Centre, Oslo, Norway; University of Oslo, Oslo; Division of Hematology and Oncology, Stavanger University Hospital, Stavanger; Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology, Radiology, and Clinical Immunology, University of Uppsala; Department of
| | - Åke Berglund
- From the Departments of Medical Oncology and Surgery, Norwegian Radium Hospital; Ullevål University Hospital, Cancer Centre, Oslo, Norway; University of Oslo, Oslo; Division of Hematology and Oncology, Stavanger University Hospital, Stavanger; Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology, Radiology, and Clinical Immunology, University of Uppsala; Department of
| | - Elke Birkemeyer
- From the Departments of Medical Oncology and Surgery, Norwegian Radium Hospital; Ullevål University Hospital, Cancer Centre, Oslo, Norway; University of Oslo, Oslo; Division of Hematology and Oncology, Stavanger University Hospital, Stavanger; Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology, Radiology, and Clinical Immunology, University of Uppsala; Department of
| | - Gunilla Frykholm
- From the Departments of Medical Oncology and Surgery, Norwegian Radium Hospital; Ullevål University Hospital, Cancer Centre, Oslo, Norway; University of Oslo, Oslo; Division of Hematology and Oncology, Stavanger University Hospital, Stavanger; Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology, Radiology, and Clinical Immunology, University of Uppsala; Department of
| | - Lars Påhlman
- From the Departments of Medical Oncology and Surgery, Norwegian Radium Hospital; Ullevål University Hospital, Cancer Centre, Oslo, Norway; University of Oslo, Oslo; Division of Hematology and Oncology, Stavanger University Hospital, Stavanger; Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology, Radiology, and Clinical Immunology, University of Uppsala; Department of
| | - Johan N. Wiig
- From the Departments of Medical Oncology and Surgery, Norwegian Radium Hospital; Ullevål University Hospital, Cancer Centre, Oslo, Norway; University of Oslo, Oslo; Division of Hematology and Oncology, Stavanger University Hospital, Stavanger; Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology, Radiology, and Clinical Immunology, University of Uppsala; Department of
| | - Per Byström
- From the Departments of Medical Oncology and Surgery, Norwegian Radium Hospital; Ullevål University Hospital, Cancer Centre, Oslo, Norway; University of Oslo, Oslo; Division of Hematology and Oncology, Stavanger University Hospital, Stavanger; Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology, Radiology, and Clinical Immunology, University of Uppsala; Department of
| | - Krzysztof Bujko
- From the Departments of Medical Oncology and Surgery, Norwegian Radium Hospital; Ullevål University Hospital, Cancer Centre, Oslo, Norway; University of Oslo, Oslo; Division of Hematology and Oncology, Stavanger University Hospital, Stavanger; Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology, Radiology, and Clinical Immunology, University of Uppsala; Department of
| | - Bengt Glimelius
- From the Departments of Medical Oncology and Surgery, Norwegian Radium Hospital; Ullevål University Hospital, Cancer Centre, Oslo, Norway; University of Oslo, Oslo; Division of Hematology and Oncology, Stavanger University Hospital, Stavanger; Department of Oncology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Oncology and Pathology, Karolinska Institutet, Stockholm; Department of Oncology, Radiology, and Clinical Immunology, University of Uppsala; Department of
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Uehara K, Shimoda T, Nakanishi Y, Taniguchi H, Akasu T, Fujita S, Yamamoto S, Moriya Y. Clinicopathological significance of fibrous tissue around fixed recurrent rectal cancer in the pelvis. Br J Surg 2007; 94:1530-5. [PMID: 17854114 DOI: 10.1002/bjs.5696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abstract
Background
Fibrous tissue around a locally recurrent rectal tumour is an interesting histological feature, but its clinicopathological significance has not been investigated.
Methods
This retrospective study examined clinicopathological findings in 48 patients who underwent curative total pelvic exenteration with distal sacrectomy (TPES) between 1992 and 2004. Data were analysed with respect to fibrosis around the recurrent tumour, categorized into one of three groups: no fibrosis (f0), partial fibrosis (f1) or circumferential fibrosis (f2).
Results
Ten, 17 and 21 patients had f0, f1 and f2 fibrosis respectively, with 5-year survival of none, four and eight patients respectively. The overall survival of patients with circumferential fibrosis was significantly better than that in patients with no fibrosis (P = 0·003). Univariable analysis showed that a high level of sacrectomy (P = 0·036), absence of lymphatic invasion (P = 0·031) and circumferential fibrosis (P = 0·039) were significantly associated with better overall survival. In multivariable analysis, circumferential fibrosis (P = 0·031) and low serum carcinoembryonic antigen levels (P = 0·044) were independent factors for a favourable outcome.
Conclusion
The outcome of patients with locally recurrent rectal cancer after curative TPES appears to be better when circumferential fibrosis is present around the tumour.
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Affiliation(s)
- K Uehara
- Colorectal Surgery Division, National Cancer Centre Hospital and Research Institute, Tokyo, Japan
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Asoglu O, Karanlik H, Muslumanoglu M, Igci A, Emek E, Ozmen V, Kecer M, Parlak M, Kapran Y. Prognostic and predictive factors after surgical treatment for locally recurrent rectal cancer: a single institute experience. Eur J Surg Oncol 2007; 33:1199-206. [PMID: 17400423 DOI: 10.1016/j.ejso.2007.02.026] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 02/20/2007] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Resection of locally recurrent rectal cancer (LRRC) after curative resection represents a difficult problem and a surgical challenge. The aim of this study was to evaluate the results of resecting the local recurrence of rectal cancer and to analyze factors that might predict curative resection and those that affect survival. PATIENTS AND METHODS A retrospective review was performed in 50 patients who underwent surgical exploration with intent to cure LRRC between April 1998 and April 2005. All of the patients had previously undergone resection of primary rectal adenocarcinoma. Of these patients' charts, operation and pathology reports were reviewed. Primary tumor and treatment details, hospital of initial treatment and TNM stage were registered. The following data were collected concerning the detection of the local recurrence; date of recurrence, symptoms at the time of presentation and diagnostic work-up. Perioperative complication and date of discharge were also gathered. The recurrent tumors were classified as not fixed (F0), fixed at one site (F1) and fixed to two or more sites (F2) according to the preoperative and peroperative findings. Microscopic involvement of surgical margins and localization of recurrence were noted based on pathology reports. RESULTS The median time interval between resection of primary tumor and surgery for locally recurrent disease was 24 (4-113) months. In a statistical analysis, initial surgery, complaints of patients, increasing number of sites of the recurrent tumor fixation in the pelvis, location of the recurrent tumor were associated with curative surgery. Curative, negative resection margins were obtained in 24 (48%) of patients; in these patients a median survival of 28 months was achieved, compared to 12 months (p=0.01) in patients with either microscopic or gross residual disease. Primary operation and CEA level at recurrence were also found to be important factors associated with improved survival. There was no operative mortality and, the complication rate was 24%. CONCLUSIONS This study demonstrated that many patients with LRRC can be resected with negative margins. The type of primary surgery, symptoms, location, and fixity of recurrent tumor are associated with the increased possibility of carrying out curative resection. Previous surgery and curative surgery are significant predictors of both disease-specific survival and overall survival.
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Affiliation(s)
- O Asoglu
- Department of Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey.
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Palmer G, Martling A, Cedermark B, Holm T. A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol 2006; 14:447-54. [PMID: 17139457 DOI: 10.1245/s10434-006-9256-9] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 09/19/2006] [Accepted: 09/21/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although outcome in patients with rectal cancer has improved with preoperative radiotherapy and total mesorectal excision, local recurrence still remains a problem. The condition is difficult to cure and little is known on whether the prognosis for patients with locally recurrent tumours has changed over time. Few population-based studies have been performed. METHOD Two thousand three hundred and eighteen patients in Stockholm, Sweden had a potentially curative resection for rectal cancer between 1995 and 2003. Until 2005, 141 (6%) developed a local recurrence. Management and outcome for these patients were studied and compared to a previously analysed cohort of 156 patients with local recurrence, treated 1980-1991. RESULTS Of the 141 patients, 57 (40%) had surgery with a curative intent, 48 (34%) radio- and/or chemotherapy and 36 (26%) symptomatic palliation only. The total 5-year survival was 9%. Twenty-five patients had a potentially curative resection, with a 5-year survival of 57%. The corresponding figures for the 156 patients in the earlier cohort were 4 and 42%. CONCLUSION Although outcome for patients with local recurrence of rectal cancer is dismal, the prognosis has improved slightly over time. A radical resection is a prerequisite for cure and the proportion having a potentially curative resection has increased. Multidisciplinary management, including optimised preoperative staging and patient selection for surgery, radical surgical approach and more effective adjuvant treatments are necessary to further improve the prognosis.
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Affiliation(s)
- G Palmer
- Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden.
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Yasui M, Ikeda M, Sekimoto M, Yamamoto H, Takemasa I, Ueda T, Shimizu J, Fukunaga M, Suzuki O, Inoue T, Monden M. Preliminary results of phase I trial of oral uracil/tegafur (UFT), leucovorin plus irinotecan and radiation therapy for patients with locally recurrent rectal cancer. World J Surg Oncol 2006; 4:83. [PMID: 17118210 PMCID: PMC1664567 DOI: 10.1186/1477-7819-4-83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 11/22/2006] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Surgical attempts for locally recurrent rectal cancer often fail due to local re-recurrence and distant metastasis. Preoperative chemoradiation may enhance better local control and survival. The aim of this study was to assess the safety of oral uracil and tegafur (UFT) plus leucovorin (LV), and irinotecan combined with radiation and determine the maximum-tolerated dose (MTD) and dose limiting toxicity (DLT) of the triple drug regimen. PATIENTS AND METHODS Patients with locally recurrent rectal cancer received escalating doses of irinotecan on days 1, 8, 15, and 22 (starting at 30 mg/m2, with 10 mg increments between consecutive cohorts) and fixed doses of UFT (300 mg/m2) plus LV (75 mg/day) on days 3 to 7, 10 to 14, 17 to 21, and 24 to 28. Radiation was given 5 days per week totaling 40 to 50 Gy (2Gy/day). RESULTS Six patients were treated at the starting dose, and 2 received the full scheduled chemoradiotherapy. The other 4 patients had grade 3 diarrhea and diarrhea was the DLT. One patient had partial response and he had subsequently radical surgical resection. Median progression free survival for local recurrence was 320 days. CONCLUSION Irinotecan plus UFT/LV with concomitant radiotherapy in patients with locally recurrent rectal cancer was not feasible due to diarrhea in this setting. Modification of the treatment is needed.
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Affiliation(s)
- Masayoshi Yasui
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masataka Ikeda
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hirofumi Yamamoto
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ichiro Takemasa
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takafumi Ueda
- Department of Orthopeadics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Junzo Shimizu
- Department of Surgery, Sakai Municipal Hospital, Osaka, Japan
| | | | - Osamu Suzuki
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takehiro Inoue
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Morito Monden
- Department of Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Krempien R, Roeder F, Oertel S, Roebel M, Weitz J, Hensley FW, Timke C, Funk A, Bischof M, Zabel-Du Bois A, Niethammer AG, Eble MJ, Buchler MW, Treiber M, Debus J. Long-term results of intraoperative presacral electron boost radiotherapy (IOERT) in combination with total mesorectal excision (TME) and chemoradiation in patients with locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 2006; 66:1143-51. [PMID: 16979835 DOI: 10.1016/j.ijrobp.2006.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 06/02/2006] [Accepted: 06/15/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND We analyzed the long-term results of patients with locally advanced rectal cancer using a multimodal approach consisting of total mesorectal excision (TME), intraoperative electron-beam radiation therapy (IOERT), and pre- or postoperative chemoradiation (CRT). PATIENTS AND METHODS Between 1991 and 2003, 210 patients with locally advanced rectal cancer (65 International Union Against Cancer [UICC] Stage II, 116 UICC Stage III, and 29 UICC Stage IV cancers) were treated with TME, IOERT, and preoperative or postoperative CHT. A total of 122 patients were treated postoperatively; 88 patients preoperatively. Preoperative or postoperative fluoropyrimidine-based CRT was applied in 93% of these patients. RESULTS Median age was 61 years (range, 26-81). Median follow-up was 61 months. The 5-year actuarial overall survival (OS), disease-free survival (DFS), local control rate (LC), and distant relapse free survival (DRS) of all patients was 69%, 66%, 93%, and 67%, respectively. Multivariate analysis revealed that UICC stage and resection status were the most important independent prognostic factors for OS, DFS, and DRS. The resection status was the only significant factor for local control. T-stage, tumor localization, type of resection, and type of chemotherapy had no significant impact on OS, DFS, DRS, and LC. Acute and late complications > or =Grade 3 were seen in 17% and 13% of patients, respectively. CONCLUSION Multimodality treatment with TME and IOERT boost in combination with moderate dose pre- or postoperative CRT is feasible and results in excellent long-term local control rates in patients with intermediate to high-risk locally advanced rectal cancer.
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Affiliation(s)
- Robert Krempien
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
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Calvo FA, Meirino RM, Orecchia R. intraoperative radiation therapy part 2. Clinical results. Crit Rev Oncol Hematol 2006; 59:116-27. [PMID: 16859922 DOI: 10.1016/j.critrevonc.2006.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 03/30/2006] [Accepted: 04/13/2006] [Indexed: 12/12/2022] Open
Abstract
Intraoperative radiation therapy (IORT) has been used for over 30 years in Asia, Europe and America as a supplementary activity in the treatment of cancer patients with promising results. Modern IORT is carried out with electron beams (IOERT) produced by a linear accelerator generally used for external beam irradiation (EBRT) or a specialized mobile electron accelerator. HDR brachytherapy (HDR-IORT) has also been applied on selected locations. Retrospective analysis of clinical experiences in cancer sites such as operable pancreatic tumour, locally advanced/recurrent rectal cancer, head and neck carcinomas, sarcomas and cervical cancer are consistent with local tumour control promotion compared to similar clinical experiences without IORT. New emerging indications such as the treatment of breast cancer are presented. The IORT component of the therapeutical approach allows intensification of the total radiation dose without additional exposure of healthy tissues and improves dose-deposit homogeneity and precision. Results of the application of IORT on selected disease sites are presented with an analysis on future possibilities. To improve the methodology, clinical trials are required with multivariate analysis including patient, tumour and treatment characteristics, prospective evaluation of early and late toxicity, patterns of tumour recurrence and overall patient outcome.
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Affiliation(s)
- Felipe A Calvo
- Hospital General Universitario Gregorio Marañon, Madrid, Spain.
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Messiou C, Chalmers A, Boyle K, Sagar P. Surgery for recurrent rectal carcinoma: The role of preoperative magnetic resonance imaging. Clin Radiol 2006; 61:250-8. [PMID: 16488206 DOI: 10.1016/j.crad.2005.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 10/24/2005] [Accepted: 11/01/2005] [Indexed: 12/13/2022]
Abstract
Despite apparent curative resection of rectal carcinoma, local recurrence rates of between 3 and 32% have been reported. For those patients, radical surgical resection offers the only hope of cure. We present a review of the magnetic resonance imaging (MRI) findings and contraindications to curative surgery demonstrated using imaging.
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Abstract
Despite radical surgery, up to 33% of patients with rectal cancer will develop locoregional relapse. The management of these patients is particularly challenging. Surgery is the mainstay of treatment for those with a mobile recurrence. However, the majority of patients develop recurrence involving the pelvic wall. In these patients, multimodality therapy including radical surgery and intraoperative radiotherapy have been reported with 5-year survival of up to 31% and local control rates of 50-71%. The most important factor for obtaining long-term local control and survival is R0 resection. Extended surgery such as abdomino-sacral resection has not been popular because of 5-year survival rates of 16-31%, and significant postoperative morbidity. Re-recurrence following surgery occurs locally and in the lung, and remains a significant problem. In surgical treatment for local recurrence, surgeon-related factors are crucial. A staging system using degree of fixation and other prognostic factors should be developed so that appropriate treatment modalities are applied to each case.
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Affiliation(s)
- Yoshihiro Moriya
- Colorectal Surgery Division, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan.
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Valentini V, Morganti AG, Gambacorta MA, Mohiuddin M, Doglietto GB, Coco C, De Paoli A, Rossi C, Di Russo A, Valvo F, Bolzicco G, Dalla Palma M. Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: A multicentric phase II study. Int J Radiat Oncol Biol Phys 2006; 64:1129-39. [PMID: 16414206 DOI: 10.1016/j.ijrobp.2005.09.017] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Revised: 08/30/2004] [Accepted: 09/07/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE The combination of irradiation and total mesorectal excision for rectal carcinoma has significantly lowered the incidence of local recurrence. However, a new problem is represented by the patient with locally recurrent cancer who has received previous irradiation to the pelvis. In these patients, local recurrence is very often not easily resectable and reirradiation is expected to be associated with a high risk of late toxicity. The aim of this multicenter phase II study is to evaluate the response rate, resectability rate, local control, and treatment-related toxicity of preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis. METHODS AND MATERIALS Patients with histologically proven pelvic recurrence of rectal carcinoma, with the absence of extrapelvic disease or bony involvement and previous pelvic irradiation with doses < or =55 Gy; age > or =18 years; performance status (PS) (Karnofsky) > or =60, and who gave institutional review board-approved written informed consent were treated by preoperative chemoradiation. Radiotherapy was delivered to a planning target volume (PTV2) including the gross tumor volume (GTV) plus a 4-cm margin, with a dose of 30 Gy (1.2 Gy twice daily with a minimum 6-h interval). A boost was delivered, with the same fractionation schedule, to a PTV1 including the GTV plus a 2-cm margin (10.8 Gy). During the radiation treatment, concurrent chemotherapy was delivered (5-fluorouracil, protracted intravenous infusion, 225 mg/m(2)/day, 7 days per week). Four to 6 weeks after the end of chemoradiation, patients were evaluated for tumor resectability, and, when feasible, surgical resection of recurrence was performed between 6-8 weeks from the end of chemoradiation. Adjuvant chemotherapy was prescribed to all patients, using Raltitrexed, 3 mg/square meter (sm), every 3 weeks, for a total of 5 cycles. Patients were staged using the computed tomography (CT)-based F-classification (F0: no side-wall involvement; F1, F2, F3: 1, 2, and 3-4 side-walls involved, respectively). Toxicity was evaluated on the basis of the Radiation Therapy Oncology Group (RTOG) criteria. RESULTS Fifty-nine patients (38 male, 21 female; median age, 62 years; range, 43-77 years) were enrolled in the study, by 12 different Italian radiotherapy departments. Previous surgery was anterior resection in 45 patients (76.3%) and abdominal-perineal resection in 14 patients (23.7%); previous radiotherapy dosage ranged between 30 and 55 Gy (median, 50.4 Gy); the median interval between prior radiation therapy to the onset of reirradiation was 27 months (range, 9-106 months); 44 patients (74.6%) had received some form of previous chemotherapy (concurrent and/or adjuvant). Fifty-one of 59 patients (86.4%) completed chemoradiation without treatment interruptions: 6 patients (10.2%) had temporary treatment interruption due to toxicity or patient compliance, and 2 patients (3.4%) had definitive treatment interruption. The incidence of Grade 3 lower gastrointestinal acute toxicity was only 5.1%. No patient developed Grade 4 acute toxicity. After chemoradiation, 5 patients (8.5%) had complete response (CR), 21 patients (35.6%) had partial response (PR), 31 patients (52.6%) had no change (NC) and 2 patients (3.4%) showed progressive disease (PD). Overall, the response rate (PR + CR) was 44.1% (95% confidence interval, 29.0-58.9%). Twenty of 24 patients (83.3%) with pelvic pain before treatment had symptomatic response. Tumor resection was performed in 30 of 59 patients (50.8%) including 2 local excisions, 4 anterior resections, 18 abdominoperineal resections, and 6 other. Surgical resection resulted as R0 and R1 in 21 patients (35.6%) and 3 patients (5.1%), respectively. The possibility of radical resection was influenced by tumor response to chemoradiation (PD/NC: 7/33; PR/CR: 14/26; p = 0.009). Thirty-three patients received adjuvant chemotherapy, which was completed in 30 (50.8%). At a median follow-up of 36 months (range, 9-69 months), 28 patients (47.5%) developed local recurrence or tumor progression in the unresected pelvic disease and 18 patients (30.5%) developed distant metastasis. Seven patients showed late toxicity, including 2 skin fibrosis, 2 impotence, 2 urinary complications requiring nephrostomy, and 1 small bowel fistula requiring surgical diversion. Overall median survival was 42 months. Five-year actuarial survival was 39.3%; 66.8% in R0 resected patients and 22.3% in patients treated without surgery or undergoing subtotal tumor removal. Local control and disease-free survival were significantly correlated with the interval between surgical treatment for primary tumor and local recurrence (p = 0.028 and p = 0.003, respectively). Radical resection significantly influenced local control, disease-free survival, and overall survival (p = 0.010, p = 0.010, and p = 0.050 respectively). The multivariate analysis confirmed the impact of surgery-relapse interval on local control (p = 0.016) and disease-free survival (p = 0.002), and confirmed the correlation between R0 surgery with local control and disease-free survival (p = 0.016). CONCLUSIONS Use of hyperfractionated chemoradiation was associated with a low rate of acute toxicity and an acceptable incidence of late complications. Pain control was excellent. The overall 5-year survival was 39%. Despite 87.4% of patients having F1-3 stage disease, approximately one-third (35%) achieved R0 resection, and two-thirds of patients in this cohort of patients were alive at the 5-year mark. However, further studies using innovative treatment algorithms are warranted to, hopefully, improve the local tumor response and control.
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Affiliation(s)
- Vincenzo Valentini
- Department of Radiation Therapy, Università Cattolica del Sacro Cuore, Rome, Italy.
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Caricato M, Borzomati D, Ausania F, Valeri S, Rosignoli A, Coppola R. Prognostic factors after surgery for locally recurrent rectal cancer: an overview. Eur J Surg Oncol 2005; 32:126-32. [PMID: 16377120 DOI: 10.1016/j.ejso.2005.11.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 11/08/2005] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Local recurrence of rectal cancer occurs in a considerable group of patients who have undergone radical treatment for primary tumour. The treatment of choice is surgical resection but the prognosis remains poor, as a negative margin excision is possible in only a small subset of patients. A review of prognostic factors for locally recurrent rectal cancer (LRRC) after surgery is presented. METHODS We systematically reviewed the literature for reports on prognostic factors after surgical excision of LRRC. These reports were identified through a review of the Medline database from 1982 to 2004. RESULTS This review highlights the most important prognostic factors for LRRC patients treated with surgery. Data are grouped on the basis of the prognostic factors investigated. CONCLUSIONS R0 resection seems to be the only reliable prognostic factor; however, symptoms, pre-operative CEA doubling time, performance status and pre-operative radiotherapy can help patient selection before surgery. The results of this review provide the basis for improved outcome, aiming to assess patients who would benefit from reoperation.
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Affiliation(s)
- M Caricato
- Department of Surgery, Campus Bio-Medico University, Rome, Italy
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Ambrosini-Spaltro A, Salvi F, Betts CM, Frezza GP, Piemontese A, Del Prete P, Baldoni C, Foschini MP, Viale G. Oncocytic modifications in rectal adenocarcinomas after radio and chemotherapy. Virchows Arch 2005; 448:442-8. [PMID: 16365727 DOI: 10.1007/s00428-005-0137-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 11/17/2005] [Accepted: 11/18/2005] [Indexed: 10/25/2022]
Abstract
The purpose of the study is to highlight oncocytic modifications in rectal adenocarcinomas and evaluate a possible correlation with preoperative radiochemotherapy (RCT). Twenty-eight cases of advanced rectal carcinoma, treated preoperatively by 5-fluorouracil (200-225 mg/m(2)) and 44-46 Gy in 22-23 fractions, were studied. All patients underwent biopsy before RCT. Surgery was performed within 6 weeks after RCT. In all cases oncocytic modifications were searched for on hematoxylin and eosin (H&E) and at immunohistochemistry using an antimitochondrial antibody. In addition, in two cases, both pre- and post-RCT tissues were examined at electron microscopy. All tumors were adenocarcinomas. In pre-RCT biopsies, oncocytic changes were difficult to find on H&E, while the antimitochondrial antibody strongly stained numerous neoplastic cells (mean 48.4%). In post-RCT surgical specimens, oncocytic changes were detected in 24 out of 28 cases on H&E and the antimitochondrial antibody stained most of the residual neoplastic cells (mean 76.7%). Ultrastructural examination revealed large and bizarre mitochondria inside tumor cells both in pre- and post-RCT tissues. In conclusion, the present data suggest that rectal adenocarcinomas are "mitochondrion-rich" tumors. After preoperative RCT, residual neoplastic cells acquire a definite oncocytic phenotype.
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Affiliation(s)
- Andrea Ambrosini-Spaltro
- Section of Anatomic Pathology M. Malpighi, University of Bologna, Bellaria Hospital, Bologna, Italy
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Minsky BD. Treatment of Unresectable/Recurrent Rectal Cancer with External Beam and/or Intraoperative Radiation Techniques. SEMINARS IN COLON AND RECTAL SURGERY 2005. [DOI: 10.1053/j.scrs.2005.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer. Surg Oncol Clin N Am 2005; 14:225-38. [PMID: 15817236 DOI: 10.1016/j.soc.2004.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Yoshihiro Moriya
- Department of Surgery, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan.
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