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Peng J, Partanen A, Pichardo S, Staruch R, Perry K, McGuffin M, Huang Y, Chan KK, Wong S, Czarnota G, Hynynen K, Chu W. Mild hyperthermia with magnetic resonance- guided high intensity focused ultrasound combined with salvage chemoradiation for recurrent rectal cancer. Int J Hyperthermia 2024; 41:2365385. [PMID: 38897584 DOI: 10.1080/02656736.2024.2365385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Pelvic recurrences from rectal cancer present a challenging clinical scenario. Hyperthermia represents an innovative treatment option in combination with concurrent chemoradiation to enhance therapeutic effect. We provide the initial results of a prospective single center feasibility study (NCT02528175) for patients undergoing rectal cancer retreatment using concurrent chemoradiation and mild hyperthermia with MR-guided high intensity focused ultrasound (MR-HIFU). METHODS All patients were deemed ineligible for salvage surgery and were evaluated in a multidisciplinary fashion with a surgical oncologist, radiation oncologist and medical oncologist. Radiation was delivered to a dose of 30.6 Gy in 1.8 Gy per fraction with concurrent capecitabine. MR-HIFU was delivered on days 1, 8 and 15 of concurrent chemoradiation. Our primary objective was feasibility and toxicity. RESULTS Six patients (total 11 screened) were treated with concurrent chemoradiation and mild hyperthermia with MR-HIFU. Tumor size varied between 3.1-16.6 cm. Patients spent an average of 228 min in the MRI suite and sonication with the external transducer lasted an average of 35 min. There were no complications on the day of the MR-HIFU procedure and all acute toxicities (no grade >/=3 toxicities) resolved after completion of treatment. There were no late grade >/=3 toxicities. CONCLUSION Mild hyperthermia with MR-HIFU, in combination with concurrent chemoradiation for appropriately selected patients, is safe for localized pelvic recurrences from rectal cancer. The potential for MR-HIFU to be applied in the recurrent setting in rectal cancer treatment requires further technical development and prospective evaluation.
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Affiliation(s)
- Jonathan Peng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | | | - Samuel Pichardo
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Kaitlyn Perry
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Merrylee McGuffin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Yuexi Huang
- Department of Medical Biophysics, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Kelvin Kw Chan
- Department of Medical Oncology, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Shun Wong
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Greg Czarnota
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
- Department of Medical Biophysics, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Kullervo Hynynen
- Department of Medical Biophysics, Sunnybrook Research Institute, Toronto, ON, Canada
| | - William Chu
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
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Piqeur F, Creemers DMJ, Banken E, Coolen L, Tanis PJ, Maas M, Roef M, Marijnen CAM, van Hellemond IEG, Nederend J, Rutten HJT, Peulen HMU, Burger JWA. Dutch national guidelines for locally recurrent rectal cancer. Cancer Treat Rev 2024; 127:102736. [PMID: 38696903 DOI: 10.1016/j.ctrv.2024.102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/04/2024]
Abstract
Due to improvements in treatment for primary rectal cancer, the incidence of LRRC has decreased. However, 6-12% of patients will still develop a local recurrence. Treatment of patients with LRRC can be challenging, because of complex and heterogeneous disease presentation and scarce - often low-grade - data steering clinical decisions. Previous consensus guidelines have provided some direction regarding diagnosis and treatment, but no comprehensive guidelines encompassing all aspects of the clinical management of patients with LRRC are available to date. The treatment of LRRC requires a multidisciplinary approach and overarching expertise in all domains. This broad expertise is often limited to specific expert centres, with dedicated multidisciplinary teams treating LRRC. A comprehensive, narrative literature review was performed and used to develop the Dutch National Guideline for management of LRRC, in an attempt to guide decision making for clinicians, regarding the complete clinical pathway from diagnosis to surgery.
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Affiliation(s)
- Floor Piqeur
- Department of Radiation Oncology, Catharina Hospital, Michelangelolaan 2 5623EJ, Eindhoven, the Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121 1066 CX, Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Centre, Albinusdreef 2 2333ZA, Leiden, the Netherlands
| | - Davy M J Creemers
- GROW School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40 6229ER, Maastricht, the Netherlands; Department of Surgery, Catharina Hospital, Michelangelolaan 2 5623EJ, Eindhoven, the Netherlands
| | - Evi Banken
- GROW School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40 6229ER, Maastricht, the Netherlands; Department of Medical Oncology, Catharina Hospital, Michelangelolaan 2 5623 EJ, Eindhoven, the Netherlands
| | - Liën Coolen
- Department of Radiology, Catharina Hospital, Michelangelolaan 2 5623 EJ, Eindhoven, the Netherlands
| | - Pieter J Tanis
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Centre, Dr. Molewaterplein 40 3015 GD, Rotterdam, the Netherlands
| | - Monique Maas
- GROW School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40 6229ER, Maastricht, the Netherlands; Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121 1066 CX, Amsterdam, the Netherlands
| | - Mark Roef
- Department of Nuclear Medicine, Catharina Hospital, Michelangelolaan 2 5623EJ, Eindhoven, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Leiden University Medical Centre, Albinusdreef 2 2333ZA, Leiden, the Netherlands
| | - Irene E G van Hellemond
- Department of Medical Oncology, Catharina Hospital, Michelangelolaan 2 5623 EJ, Eindhoven, the Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2 5623 EJ, Eindhoven, the Netherlands
| | - Harm J T Rutten
- GROW School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40 6229ER, Maastricht, the Netherlands; Department of Surgery, Catharina Hospital, Michelangelolaan 2 5623EJ, Eindhoven, the Netherlands
| | - Heike M U Peulen
- Department of Radiation Oncology, Catharina Hospital, Michelangelolaan 2 5623EJ, Eindhoven, the Netherlands
| | - Jacobus W A Burger
- Department of Surgery, Catharina Hospital, Michelangelolaan 2 5623EJ, Eindhoven, the Netherlands.
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Takagawa Y, Suzuki M, Seto I, Azami Y, Machida M, Takayama K, Sulaiman NS, Nakasato T, Kikuchi Y, Murakami M, Honda M, Teranishi Y, Kono K. Proton beam reirradiation for locally recurrent rectal cancer patients with prior pelvic irradiation. JOURNAL OF RADIATION RESEARCH 2024; 65:379-386. [PMID: 38604182 PMCID: PMC11115468 DOI: 10.1093/jrr/rrae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/17/2024] [Indexed: 04/13/2024]
Abstract
The aim of the present study was to report the feasibility of proton beam reirradiation for patients with locally recurrent rectal cancer (LRRC) with prior pelvic irradiation. The study population included patients who were treated with proton beam therapy (PBT) for LRRC between 2008 and December 2019 in our institution. Those who had a history of distant metastases of LRRC, with or without treatment, before reirradiation, were excluded. Overall survival (OS), progression-free survival (PFS) and local control (LC) were estimated using the Kaplan-Meier method. Ten patients were included in the present study. The median follow-up period was 28.7 months, and the median total dose of prior radiotherapy (RT) was 50 Gy (range, 30 Gy-74.8 Gy). The median time from prior RT to reirradiation was 31.5 months (range, 8.1-96.6 months), and the median reirradiation dose was 72 Gy (relative biological effectiveness) (range, 56-77 Gy). The 1-year/2-year OS, PFS and LC rates were 100%/60.0%, 20.0%/10.0% and 70.0%/58.3%, respectively, with a median survival time of 26.0 months. Seven patients developed a Grade 1 acute radiation dermatitis, and no Grade ≥ 2 acute toxicity was recorded. Grade ≥ 3 late toxicity was recorded in only one patient, who had developed a colostomy due to radiation-related intestinal bleeding. Reirradiation using PBT for LRRC patients who had previously undergone pelvic irradiation was feasible. However, the indications for PBT reirradiation for LRRC patients need to be considered carefully due to the risk of severe late GI toxicity.
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Affiliation(s)
- Yoshiaki Takagawa
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Ichiro Seto
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Masanori Machida
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Kanako Takayama
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Nor Shazrina Sulaiman
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Tatsuhiko Nakasato
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
- Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Yasushi Teranishi
- Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Koji Kono
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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4
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van Geffen EGM, Langhout JMA, Hazen SJA, Sluckin TC, van Dieren S, Beets GL, Beets-Tan RGH, Borstlap WAA, Burger JWA, Horsthuis K, Intven MPW, Aalbers AGJ, Havenga K, Marinelli AWKS, Melenhorst J, Nederend J, Peulen HMU, Rutten HJT, Schreurs WH, Tuynman JB, Verhoef C, de Wilt JHW, Marijnen CAM, Tanis PJ, Kusters M, On Behalf Of The Dutch Snapshot Research Group. Evolution of clinical nature, treatment and survival of locally recurrent rectal cancer: Comparative analysis of two national cross-sectional cohorts. Eur J Cancer 2024; 202:114021. [PMID: 38520925 DOI: 10.1016/j.ejca.2024.114021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND In the Netherlands, use of neoadjuvant radiotherapy for rectal cancer declined after guideline revision in 2014. This decline is thought to affect the clinical nature and treatability of locally recurrent rectal cancer (LRRC). Therefore, this study compared two national cross-sectional cohorts before and after the guideline revision with the aim to determine the changes in treatment and survival of LRRC patients over time. METHODS Patients who underwent resection of primary rectal cancer in 2011 (n = 2094) and 2016 (n = 2855) from two nationwide cohorts with a 4-year follow up were included. Main outcomes included time to LRRC, synchronous metastases at time of LRRC diagnosis, intention of treatment and 2-year overall survival after LRRC. RESULTS Use of neoadjuvant (chemo)radiotherapy for the primary tumour decreased from 88.5% to 60.0% from 2011 to 2016. The 3-year LRRC rate was not significantly different with 5.1% in 2011 (n = 114, median time to LRRC 16 months) and 6.3% in 2016 (n = 202, median time to LRRC 16 months). Synchronous metastasis rate did not significantly differ (27.2% vs 33.7%, p = 0.257). Treatment intent of the LRRC shifted towards more curative treatment (30.4% vs. 47.0%, p = 0.009). In the curatively treated group, two-year overall survival after LRRC diagnoses increased from 47.5% to 78.7% (p = 0.013). CONCLUSION Primary rectal cancer patients in 2016 were treated less often with neoadjuvant (chemo)radiotherapy, while LRRC rates remained similar. Those who developed LRRC were more often candidate for curative intent treatment compared to the 2011 cohort, and survival after curative intent treatment also improved substantially.
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Affiliation(s)
- E G M van Geffen
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - J M A Langhout
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - S J A Hazen
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - T C Sluckin
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - G L Beets
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R G H Beets-Tan
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - W A A Borstlap
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - J W A Burger
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - K Horsthuis
- Department of Radiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M P W Intven
- Department of Radiotherapy, Division Imaging and Oncology, University Medical Centre Utrecht, the Netherlands
| | - A G J Aalbers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - K Havenga
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A W K S Marinelli
- Department of Surgery, Haaglanden Medisch Centrum, Den Haag, the Netherlands
| | - J Melenhorst
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - H M U Peulen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - W H Schreurs
- Department of Surgery, Nothwest Clinics, Alkmaar, the Netherlands
| | - J B Tuynman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - C Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - P J Tanis
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - M Kusters
- Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
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5
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Hardcastle N, Vasquez Osorio E, Jackson A, Mayo C, Aarberg AE, Ayadi M, Belosi F, Ceylan C, Davey A, Dupuis P, Handley JC, Hemminger T, Hoffmann L, Kelly C, Michailidou C, Muscat S, Murrell DH, Pérez-Alija J, Palmer C, Placidi L, Popovic M, Rønde HS, Selby A, Skopidou T, Solomou N, Stroom J, Thompson C, West NS, Zaila A, Appelt AL. Multi-centre evaluation of variation in cumulative dose assessment in reirradiation scenarios. Radiother Oncol 2024; 194:110184. [PMID: 38453055 DOI: 10.1016/j.radonc.2024.110184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE Safe reirradiation relies on assessment of cumulative doses to organs at risk (OARs) across multiple treatments. Different clinical pathways can result in inconsistent estimates. Here, we quantified the consistency of cumulative dose to OARs across multi-centre clinical pathways. MATERIAL AND METHODS We provided DICOM planning CT, structures and doses for two reirradiation cases: head & neck (HN) and lung. Participants followed their standard pathway to assess the cumulative physical and EQD2 doses (with provided α/β values), and submitted DVH metrics and a description of their pathways. Participants could also submit physical dose distributions from Course 1 mapped onto the CT of Course 2 using their best available tools. To assess isolated impact of image registrations, a single observer accumulated each submitted spatially mapped physical dose for every participating centre. RESULTS Cumulative dose assessment was performed by 24 participants. Pathways included rigid (n = 15), or deformable (n = 5) image registration-based 3D dose summation, visual inspection of isodose line contours (n = 1), or summation of dose metrics extracted from each course (n = 3). Largest variations were observed in near-maximum cumulative doses (25.4 - 41.8 Gy for HN, 2.4 - 33.8 Gy for lung OARs), with lower variations in volume/dose metrics to large organs. A standardised process involving spatial mapping of the first course dose to the second course CT followed by summation improved consistency for most near-maximum dose metrics in both cases. CONCLUSION Large variations highlight the uncertainty in reporting cumulative doses in reirradiation scenarios, with implications for outcome analysis and understanding of published doses. Using a standardised workflow potentially including spatially mapped doses improves consistency in determination of accumulated dose in reirradiation scenarios.
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Affiliation(s)
- Nicholas Hardcastle
- Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
| | | | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | | | - Myriam Ayadi
- Department of Radiation Oncology, Physics Unit, Centre Léon Bérard, Lyon, France
| | - Francesca Belosi
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Cemile Ceylan
- Department of Radiation Oncology, Istanbul Oncology Hospital, Istanbul, Turkey; Department of Medical Physics, University of Yeditepe, Istanbul, Turkey
| | - Angela Davey
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Pauline Dupuis
- Department of Radiation Oncology, Physics Unit, Centre Léon Bérard, Lyon, France
| | | | | | - Lone Hoffmann
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Colin Kelly
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - Sarah Muscat
- Department of Medical Physics, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Donna H Murrell
- Department of Oncology, Western University, London, Ontario, Canada; London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Jaime Pérez-Alija
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Catherine Palmer
- Department of Radiotherapy Physics, Norfolk and Norwich University Hospitals, NHS Foundation Trust, UK
| | - Lorenzo Placidi
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Marija Popovic
- Department of Medical Physics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Heidi S Rønde
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Adam Selby
- South West Wales Cancer Centre, Swansea, Wales, UK
| | | | - Natasa Solomou
- Department of Radiotherapy Physics, Norfolk and Norwich University Hospitals, NHS Foundation Trust, UK
| | - Joep Stroom
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | | | - Ali Zaila
- Biomedical Physics Department, King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh, Saudi Arabia
| | - Ane L Appelt
- Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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Huma C, Hawon L, Sarisha J, Erdal T, Kevin C, Valentina KA. Advances in the field of developing biomarkers for re-irradiation: a how-to guide to small, powerful data sets and artificial intelligence. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2024; 9:3-16. [PMID: 38550554 PMCID: PMC10972602 DOI: 10.1080/23808993.2024.2325936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/28/2024] [Indexed: 04/01/2024]
Abstract
Introduction Patient selection remains challenging as the clinical use of re-irradiation (re-RT) increases. Re-RT data is limited to retrospective studies and small prospective single-institution reports, resulting in small, heterogenous data sets. Validated prognostic and predictive biomarkers are derived from large-volume studies with long-term follow-up. This review aims to examine existing re-RT publications and available data sets and discuss strategies using artificial intelligence (AI) to approach small data sets to optimize the use of re-RT data. Methods Re-RT publications were identified where associated public data was present. The existing literature on small data sets to identify biomarkers was also explored. Results Publications with associated public data were identified, with glioma and nasopharyngeal cancers emerging as the most common tumor sites where the use of re-RT was the primary management approach. Existing and emerging AI strategies have been used to approach small data sets including data generation, augmentation, discovery, and transfer learning. Conclusions Further data is needed to generate adaptive frameworks, improve the collection of specimens for molecular analysis, and improve the interpretability of results in re-RT data.
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Affiliation(s)
- Chaudhry Huma
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
| | - Lee Hawon
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
| | - Jagasia Sarisha
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
| | - Tasci Erdal
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
| | - Camphausen Kevin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
| | - Krauze Andra Valentina
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Bethesda, MD, 20892, United States
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7
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Cai X, Li P, Zhao J, Wang W, Cheng J, Zhang G, Cai S, Zhang Z, Jiang G, Zhang Q, Wang Z. Definitive carbon ion re-irradiation with pencil beam scanning in the treatment of unresectable locally recurrent rectal cancer. JOURNAL OF RADIATION RESEARCH 2023; 64:933-939. [PMID: 37738440 PMCID: PMC10665299 DOI: 10.1093/jrr/rrad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/04/2023] [Indexed: 09/24/2023]
Abstract
This study aimed to evaluate the oncological outcomes and safety of carbon ion re-irradiation with pencil beam scanning (PBS) delivery technique for previously irradiated and unresectable locally recurrent rectal cancer (LRRC). Between June 2017 and September 2021, 24 patients of unresectable LRRC with prior pelvic photon radiotherapy who underwent carbon ion re-irradiation at our institute were retrospectively analyzed. Carbon ion radiotherapy was delivered by raster scanning with a median relative biological effectiveness-weighted dose of 72 Gy in 20 fractions. Weekly CT reviews were carried out, and offline adaptive replanning was performed whenever required. The median follow-up duration was 23.8 months (range, 6.2-47.1 months). At the last follow-up, two patients had a local disease progression, and 11 patients developed distant metastases. The 1- and 2-year local control, progression-free survival and overall survival rates were 100 and 93.3%, 70.8 and 45.0% and 86.7 and 81.3%, respectively. There were no Grade 3 or higher acute toxicities observed. Three patients developed Grade 3 late toxicities, one each with gastrointestinal toxicity, skin reaction and pelvic infection. In conclusion, definitive carbon ion re-irradiation with PBS provided superior oncologic results with tolerable toxicities and may be served as a curative treatment strategy in unresectable LRRC.
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Affiliation(s)
- Xin Cai
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Ping Li
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jingfang Zhao
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Weiwei Wang
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Jingyi Cheng
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Guangyuan Zhang
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Radiology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Guoliang Jiang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Zheng Wang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
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8
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Wan J, Wu R, Fu M, Shen L, Zhang H, Wang Y, Wang Y, Zhou S, Chen Y, Xia F, Zhang Z. TORCH-R trial protocol: hypofractionated radiotherapy combined with chemotherapy and toripalimab for locally recurrent rectal cancer: a prospective, single-arm, two-cohort, phase II trial. Front Oncol 2023; 13:1304767. [PMID: 38053659 PMCID: PMC10694348 DOI: 10.3389/fonc.2023.1304767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
For patients with locally recurrent rectal cancer (LRRC), the response rate to chemoradiotherapy is 40%-50%. Additionally, only approximately 40%-50% of patients with recurrent rectal cancer are able to undergo R0 resection. Recent studies in locally advanced rectal cancer (LARC) have shown promising synergistic effects when combining immunotherapy (PD-1/PD-L1 antibodies) with neoadjuvant chemoradiotherapy (nCRT). Therefore, incorporating immunotherapy into the treatment regimen for LRRC patients has the potential to further improve response rates and prognosis. To investigate this, the TORCH-R trial was conducted. This prospective, single-arm, two-cohort, phase II trial focuses on the use of hypofractionated radiotherapy, chemotherapy, and immunotherapy in LRRC patients without or with oligometastases. The trial will include two cohorts: cohort A consists of rectal cancer patients who are treatment-naive for local recurrence, and cohort B includes patients with progressive disease after first-line chemotherapy. Cohort A and cohort B patients will receive 25-40 Gy/5 Fx irradiation or 15-30 Gy/5 Fx reirradiation for pelvic recurrence, respectively. Subsequently, they will undergo 18 weeks of chemotherapy, toripalimab, and stereotactic ablative radiotherapy (SABR) for all metastatic lesions between chemoimmunotherapy cycles. Decisions regarding follow-up of complete response (CR), radical surgery, sustained treatment of non-resection, or exiting the trial are made by a multidisciplinary team (MDT). The primary endpoint of this study is the local objective response rate (ORR). The secondary endpoints include the extrapelvic response rate, duration of response, local recurrence R0 resection rate, progression-free survival (PFS), overall survival (OS), and safety and tolerability. Notably, this trial represents the first clinical exploration of inducing hypofractionated radiotherapy, chemotherapy, and immunotherapy in LRRC patients. Clinical trial registration https://clinicaltrials.gov/study/NCT05628038, identifier NCT05628038.
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Affiliation(s)
- Juefeng Wan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Ruiyan Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Miaomiao Fu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Lijun Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Hui Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yan Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yaqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Shujuan Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yajie Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Fan Xia
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
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9
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Nordkamp S, van Rees JM, van den Berg K, Mens DM, Creemers DMJ, Peulen HMU, Creemers GJ, Nieuwenhuijzen GAP, Tolenaar JL, Bloemen JG, Rothbarth J, Rutten HJT, Verhoef C, Burger JWA. Locally recurrent rectal cancer: oncological outcomes of neoadjuvant chemoradiotherapy with or without induction chemotherapy. Br J Surg 2023; 110:1637-1640. [PMID: 37406084 DOI: 10.1093/bjs/znad214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Stefi Nordkamp
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Jan M van Rees
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Kim van den Berg
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - David M Mens
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Davy M J Creemers
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Heike M U Peulen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Jip L Tolenaar
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Johanne G Bloemen
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Joost Rothbarth
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Cornelis Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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10
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Mantello G, Galofaro E, Bisello S, Chiloiro G, Romano A, Caravatta L, Gambacorta MA. Modern Techniques in Re-Irradiation for Locally Recurrent Rectal Cancer: A Systematic Review. Cancers (Basel) 2023; 15:4838. [PMID: 37835532 PMCID: PMC10571716 DOI: 10.3390/cancers15194838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Radiotherapy (RT) plays an important role in the treatment of patients with previously irradiated locally recurrent rectal cancer (LRRC). Over the years, numerous technologies and different types of RT have emerged. The aim of our systematic literature review was to determine whether the new techniques have led to improvements in both outcomes and toxicities. METHODS A computerized search was performed by MEDLINE and the Cochrane database. The studies reported data from patients treated with carbon ion radiotherapy (CIRT), intensity-modulated photon radiotherapy (IMRT), and stereotactic radiotherapy (SBRT). RESULTS Seven publications of the 126 titles/abstracts that emerged from our search met the inclusion criteria and presented outcomes of 230 patients. OS was reported with rates of 90.0% and 73.0% at 1 and 2 years, respectively; LC was 89.0% and 71.6% at 1 and 2 years after re-RT, respectively. Toxicity data vary widely, with emphasis on acute and chronic gastrointestinal and urogenital toxicity, even with modern techniques. CONCLUSION data on toxicity and outcomes of re-RT for LRRC with new technologies are promising compared with 3D techniques. Comparative studies are needed to define the best technique, also in relation to the site of recurrence.
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Affiliation(s)
- Giovanna Mantello
- Radiotherapy Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy; (G.M.); (S.B.)
| | - Elena Galofaro
- Radiotherapy Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy; (G.M.); (S.B.)
| | - Silvia Bisello
- Radiotherapy Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy; (G.M.); (S.B.)
| | - Giuditta Chiloiro
- Departments of Radiation Oncology, Fondazione Policlinico Universitario A.Gemelli IRCCS, 00168 Roma, Italy; (G.C.); (A.R.); (M.A.G.)
| | - Angela Romano
- Departments of Radiation Oncology, Fondazione Policlinico Universitario A.Gemelli IRCCS, 00168 Roma, Italy; (G.C.); (A.R.); (M.A.G.)
| | - Luciana Caravatta
- Department of Radiation Oncology, SS Annunziata Hospital, 66100 Chieti, Italy;
| | - Maria Antonietta Gambacorta
- Departments of Radiation Oncology, Fondazione Policlinico Universitario A.Gemelli IRCCS, 00168 Roma, Italy; (G.C.); (A.R.); (M.A.G.)
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11
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Mantello G, Galofaro E, Caravatta L, Di Carlo C, Montrone S, Arpa D, Chiloiro G, De Paoli A, Donato V, Gambacorta MA, Genovesi D, Lupattelli M, Macchia G, Montesi G, Niespolo RM, Palazzari E, Pontoriero A, Scricciolo M, Valvo F, Franco P. Pattern of care for re-irradiation in locally recurrent rectal cancer: a national survey on behalf of the AIRO gastrointestinal tumors study group. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01652-3. [PMID: 37365381 DOI: 10.1007/s11547-023-01652-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/25/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Radical resection (R0) represents the best curative treatment for local recurrence (LR) rectal cancer. Re-irradiation (re-RT) can increase the rate of R0 resection. Currently, there is a lack of guidelines on Re-RT for LR rectal cancer. The Italian Association of Radiation and clinical oncology for gastrointestinal tumors (AIRO-GI) study group released a national survey to investigate the current clinical practice of external beam radiation therapy in these patients. MATERIAL AND METHODS In February 2021, the survey was designed and distributed to members of the GI working group. The questionnaire consisted of 40 questions regarding center characteristics, clinical indications, doses, and treatment techniques of re-RT for LR rectal cancer. RESULTS A total of 37 questionnaires were collected. Re-RT was reported as an option for neoadjuvant treatment in resectable and unresectable disease by 55% and 75% of respondents, respectively. Long-course treatment with 30-40 Gy (1.8-2 Gy/die, 1.2 Gy bid) and hypofractionated regimen of 30-35 Gy in 5 fractions were used in most centers. A total dose of 90-100 Gy as EqD2 dose (α/β = 5 Gy) was delivered by 46% of the respondents considering the previous treatment. Modern conformal techniques and daily image-guided radiation therapy protocols were used in 94% of centers. CONCLUSION Our survey showed that re-RT treatment is performed with advanced technology that allow a good management of LR rectal cancer. Significant variations were observed in terms of dose and fractionation, highlighting the need for a consensus on a common treatment strategy that could be validated in prospective studies.
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Affiliation(s)
- Giovanna Mantello
- Radiotherapy Department, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126, Ancona, Italy
| | - Elena Galofaro
- Radiotherapy Department, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126, Ancona, Italy.
| | - Luciana Caravatta
- Department of Radiation Oncology, SS Annunziata Hospital, Chieti, Italy
| | - Clelia Di Carlo
- Radiotherapy Department, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126, Ancona, Italy
| | | | - Donatella Arpa
- IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Radiotherapy Unit, Meldola, Italy
| | - Giuditta Chiloiro
- Departments of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonino De Paoli
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Vittorio Donato
- Radiation Oncology Division, Oncology and Speciality Medicine Department, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Domenico Genovesi
- Department of Radiation Oncology, SS Annunziata Hospital, Chieti, Italy
| | - Marco Lupattelli
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy
| | | | | | - Elisa Palazzari
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Melissa Scricciolo
- UOC di Radioterapia Oncologica Mestre, Ospedale dell'Angelo, Venice, Mestre, Italy
| | - Francesca Valvo
- Fondazione CNAO, National Center of Oncological Hadrontherapy, Pavia, Italy
| | - Pierfrancesco Franco
- Department of Translational Medicine, Department of Radiation Oncology, Maggiore Della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
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12
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Jeans EB, Ebner DK, Takiyama H, Qualls K, Cunningham DA, Waddle MR, Jethwa KR, Harmsen WS, Hubbard JM, Dozois EJ, Mathis KL, Tsuji H, Merrell KW, Hallemeier CL, Mahajan A, Yamada S, Foote RL, Haddock MG. Comparing Oncologic Outcomes and Toxicity for Combined Modality Therapy vs. Carbon-Ion Radiotherapy for Previously Irradiated Locally Recurrent Rectal Cancer. Cancers (Basel) 2023; 15:cancers15113057. [PMID: 37297019 DOI: 10.3390/cancers15113057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
No standard treatment paradigm exists for previously irradiated locally recurrent rectal cancer (PILRRC). Carbon-ion radiotherapy (CIRT) may improve oncologic outcomes and reduce toxicity compared with combined modality therapy (CMT). Eighty-five patients treated at Institution A with CIRT alone (70.4 Gy/16 fx) and eighty-six at Institution B with CMT (30 Gy/15 fx chemoradiation, resection, intraoperative electron radiotherapy (IOERT)) between 2006 and 2019 were retrospectively compared. Overall survival (OS), pelvic re-recurrence (PR), distant metastasis (DM), or any disease progression (DP) were analyzed with the Kaplan-Meier model, with outcomes compared using the Cox proportional hazards model. Acute and late toxicities were compared, as was the 2-year cost. The median time to follow-up or death was 6.5 years. Median OS in the CIRT and CMT cohorts were 4.5 and 2.6 years, respectively (p ≤ 0.01). No difference was seen in the cumulative incidence of PR (p = 0.17), DM (p = 0.39), or DP (p = 0.19). Lower acute grade ≥ 2 skin and GI/GU toxicity and lower late grade ≥ 2 GU toxicities were associated with CIRT. Higher 2-year cumulative costs were associated with CMT. Oncologic outcomes were similar for patients treated with CIRT or CMT, although patient morbidity and cost were lower with CIRT, and CIRT was associated with longer OS. Prospective comparative studies are needed.
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Affiliation(s)
- Elizabeth B Jeans
- Department of Radiation Oncology, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | - Daniel K Ebner
- Department of Radiation Oncology, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | - Hirotoshi Takiyama
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inageku, Chiba 263-8555, Japan
| | - Kaitlin Qualls
- Department of Radiation Oncology, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | - Danielle A Cunningham
- Department of Radiation Oncology, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | - Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | - Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | - William S Harmsen
- Department of Statistics, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | - Joleen M Hubbard
- Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Eric J Dozois
- Division of Colon & Rectal Surgery, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | - Kellie L Mathis
- Division of Colon & Rectal Surgery, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inageku, Chiba 263-8555, Japan
| | - Kenneth W Merrell
- Department of Radiation Oncology, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | | | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inageku, Chiba 263-8555, Japan
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
| | - Michael G Haddock
- Department of Radiation Oncology, Mayo Clinic, 200 2nd Street SW, Rochester, MN 55905, USA
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13
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Nordkamp S, Piqeur F, van den Berg K, Tolenaar JL, van Hellemond IEG, Creemers GJ, Roef M, van Lijnschoten G, Cnossen JS, Nieuwenhuijzen GAP, Bloemen JG, Coolen L, Nederend J, Peulen HMU, Rutten HJT, Burger JWA. Locally recurrent rectal cancer: Oncological outcomes for patients with a pathological complete response after neoadjuvant therapy. Br J Surg 2023:7181206. [PMID: 37243705 DOI: 10.1093/bjs/znad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND For patients with locally recurrent rectal cancer, it is an ongoing pursuit to establish factors predicting or improving oncological outcomes. In locally advanced rectal cancer, a pCR appears to be associated with improved outcomes. The aim of this retrospective cohort study was to compare the oncological outcomes of patients with locally recurrent rectal cancer with and without a pCR. METHODS Patients who underwent neoadjuvant treatment and surgery for locally recurrent rectal cancer with curative intent between January 2004 and June 2020 at a tertiary referral hospital were analysed. Primary outcomes included overall survival, disease-free survival, metastasis-free survival, and local re-recurrence-free survival, stratified according to whether the patient had a pCR. RESULTS Of a total of 345 patients, 51 (14.8 per cent) had a pCR. Median follow-up was 36 (i.q.r. 16-60) months. The 3-year overall survival rate was 77 per cent for patients with a pCR and 51.1 per cent for those without (P < 0.001). The 3-year disease-free survival rate was 56 per cent for patients with a pCR and 26.1 per cent for those without (P < 0.001). The 3-year local re-recurrence-free survival rate was 82 and 44 per cent respectively (P < 0.001). Surgical procedures (for example soft tissue, sacrum, and urogenital organ resections) and postoperative complications were comparable between patients with and without a pCR. CONCLUSION This study showed that patients with a pCR have superior oncological outcomes to those without a pCR. It may therefore be safe to consider a watch-and-wait approach in highly selected patients, potentially improving quality of life by omitting extensive surgical procedures without compromising oncological outcomes.
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Affiliation(s)
- Stefi Nordkamp
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
- Faculty of Health, Medicine and Life Sciences, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Floor Piqeur
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Kim van den Berg
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Jip L Tolenaar
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Mark Roef
- Department of Nuclear Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Jeltsje S Cnossen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Johanne G Bloemen
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Liën Coolen
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Heike M U Peulen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
- Faculty of Health, Medicine and Life Sciences, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
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14
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Murray L, Thompson C, Pagett C, Lilley J, Al-Qaisieh B, Svensson S, Eriksson K, Nix M, Aldred M, Aspin L, Gregory S, Appelt A. Treatment plan optimisation for reirradiation. Radiother Oncol 2023; 182:109545. [PMID: 36813170 DOI: 10.1016/j.radonc.2023.109545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND The STRIDeR (Support Tool for Re-Irradiation Decisions guided by Radiobiology) project aims to create a clinically viable re-irradiation planning pathway within a commercial treatment planning system (TPS). Such a pathway should account for previously delivered dose, voxel-by-voxel, taking fractionation effects, tissue recovery and anatomical changes into account. This work presents the workflow and technical solutions in the STRIDeR pathway. METHODS The pathway was implemented in RayStation (version 9B DTK) to allow an original dose distribution to be used as background dose to guide optimisation of re-irradiation plans. Organ at risk (OAR) planning objectives in equivalent dose in 2 Gy fractions (EQD2) were applied cumulatively across the original and re-irradiation treatments, with optimisation of the re-irradiation plan performed voxel-by-voxel in EQD2. Different approaches to image registration were employed to account for anatomical change. Data from 21 patients who received pelvic Stereotactic Ablative Radiotherapy (SABR) re-irradiation were used to illustrate the use of the STRIDeR workflow. STRIDeR plans were compared to those produced using a standard manual method. RESULTS The STRIDeR pathway resulted in clinically acceptable plans in 20/21 cases. Compared to plans produced using the laborious manual method, less constraint relaxation was required or higher re-irradiation doses could be prescribed in 3/21. CONCLUSION The STRIDeR pathway used background dose to guide radiobiologically meaningful, anatomically-appropriate re-irradiation treatment planning within a commercial TPS. This provides a standardised and transparent approach, offering more informed re-irradiation and improved cumulative OAR dose evaluation.
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Affiliation(s)
- Louise Murray
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Christopher Thompson
- Department of Medical Physics, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christopher Pagett
- Department of Medical Physics, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Lilley
- Department of Medical Physics, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Bashar Al-Qaisieh
- Department of Medical Physics, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Michael Nix
- Department of Medical Physics, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Michael Aldred
- Department of Medical Physics, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lynn Aspin
- Department of Medical Physics, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stephen Gregory
- Department of Medical Physics, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ane Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Medical Physics, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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15
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van de Vlasakker VCJ, van den Heuvel TBM, Rijken A, Nienhuijs SW, Ketelaers SHJ, Verrijssen ASE, Rutten HJ, Nieuwenhuijzen GAP, Burger JWA, de Hingh IHJT. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy with Intra-Operative Radiotherapy for Patients with Locally Advanced or Locally Recurrent Rectal Cancer and Peritoneal Metastases. Cancers (Basel) 2023; 15:cancers15030858. [PMID: 36765814 PMCID: PMC9913342 DOI: 10.3390/cancers15030858] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
Purpose: To assess the safety and long-term outcome of a multimodality treatment consisting of radical surgery, intra-operative radiotherapy (IORT), and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for patients with locally advanced rectal cancer (LARC) or locally recurrent rectal carcinoma (LRRC) and peritoneal metastases (PM). Methods: The present study was a single-center cohort study, including all consecutive patients undergoing this treatment in a tertiary referral center for LARC, LRRC, and PM. Postoperative complications, intensive care stay (ICU stay), and re-admission rates were assessed as well as disease-free survival (DFS) and overall survival (OS). Results: A total of 14 LARC and 16 LRRC patients with PM were included in the study. The median ICU stay was 1 day, and 57% of patients developed a severe postoperative complication. No 90-day mortality was observed. Median DFS was 10.0 months (Interquartile Range 7.1-38.7), and median OS was 31.0 months (Interquartile Range 15.9-144.3). Conclusions: As postoperative complications and survival were in line with treatments that are accepted for LARC or LRRC and PM as separate procedures, we conclude that combined treatment with IORT and CRS-HIPEC should be considered as a treatment option for selected patients with LARC or LRRC and peritoneal metastases in tertiary referral centers.
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Affiliation(s)
| | | | - Anouk Rijken
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | - Simon W. Nienhuijs
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | | | | | - Harm J. Rutten
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
- GROW–School for Oncology and Reproduction, Maastricht University, 6211 LK Maastricht, The Netherlands
| | | | | | - Ignace H. J. T. de Hingh
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
- GROW–School for Oncology and Reproduction, Maastricht University, 6211 LK Maastricht, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organization, P.O. Box 19079, 3501 DB Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-40-239-7150
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Piqeur F, Hupkens BJP, Nordkamp S, Witte MG, Meijnen P, Ceha HM, Berbee M, Dieters M, Heyman S, Valdman A, Nilsson MP, Nederend J, Rutten HJT, Burger JWA, Marijnen CAM, Peulen HMU. Development of a consensus-based delineation guideline for locally recurrent rectal cancer. Radiother Oncol 2022; 177:214-221. [PMID: 36410547 DOI: 10.1016/j.radonc.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Neoadjuvant chemoradiotherapy (nCRT) is used in locally recurrent rectal cancer (LRRC) to increase chances of a radical surgical resection. Delineation in LRRC is hampered by complex disease presentation and limited clinical exposure. Within the PelvEx II trial, evaluating the benefit of chemotherapy preceding nCRT for LRRC, a delineation guideline was developed by an expert LRRC team. MATERIALS AND METHODS Eight radiation oncologists, from Dutch and Swedish expert centres, participated in two meetings, delineating GTV and CTV in six cases. Regions at-risk for re-recurrence or irradical resection were identified by eleven expert surgeons and one expert radiologist. Target volumes were evaluated multidisciplinary. Inter-observer variation was analysed. RESULTS Inter-observer variation in delineation of LRRC appeared large. Multidisciplinary evaluation per case is beneficial in determining target volumes. The following consensus regarding target volumes was reached. GTV should encompass all tumour, including extension into OAR if applicable. If the tumour is in fibrosis, GTV should encompass the entire fibrotic area. Only if tumour can clearly be distinguished from fibrosis, GTV may be reduced, as long as the entire fibrotic area is covered by the CTV. CTV is GTV with a 1 cm margin and should encompass all at-risk regions for irradical resection or re-recurrence. CTV should not be adjusted towards other organs. Multifocal recurrences should be encompassed in one CTV. Elective nodal delineation is only advised in radiotherapy-naïve patients. CONCLUSION This study provides a first consensus-based delineation guideline for LRRC. Analyses of re-recurrences is needed to understand disease behaviour and to optimize delineation guidelines accordingly.
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Affiliation(s)
- Floor Piqeur
- Department of Radiation Oncology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, the Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Britt J P Hupkens
- Department of Radiation Oncology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, the Netherlands; Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229ET Maastricht, the Netherlands
| | - Stefi Nordkamp
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, the Netherlands
| | - Marnix G Witte
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Philip Meijnen
- Department of Radiation Oncology, Amsterdam University Medical Centre, De Boelelaan 1118, 1081HZ Amsterdam, the Netherlands
| | - Heleen M Ceha
- Department of Radiation Oncology, Haaglanden Medical Centre, Burg. Banninglaan 1, 2262AK Leidschendam, the Netherlands
| | - Maaike Berbee
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229ET Maastricht, the Netherlands
| | - Margriet Dieters
- Department of Radiation Oncology, University Medical Centre Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Sofia Heyman
- Department of Oncology, Institute of Clinical Sciencs, Sahlgrenska Academy at University of Gothenburg, Bla straket 5, 412 45 Götenborg, Sweden
| | - Alexander Valdman
- Department of Radiation Oncology, Karolinska University Hospital, Anna Steckséns gata 41, 171 64 Stockholm, Sweden
| | - Martin P Nilsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lasarettsgatan 23, 221 85 Lund, Sweden
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, the Netherlands; GROW School of Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, 6229ER Maastricht, the Netherlands
| | - Jacobus W A Burger
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Heike M U Peulen
- Department of Radiation Oncology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, the Netherlands.
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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Harji DP, Houston F, Cutforth I, Hawthornthwaite E, McKigney N, Sharpe A, Coyne P, Griffiths B. The impact of multidisciplinary team decision-making in locally advanced and recurrent rectal cancer. Ann R Coll Surg Engl 2022; 104:611-617. [PMID: 35639482 PMCID: PMC9680687 DOI: 10.1308/rcsann.2022.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Appropriate patient selection within the context of a multidisciplinary team (MDT) is key to good clinical outcomes. The current evidence base for factors that guide the decision-making process in locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is limited to anatomical factors. METHODS A registry-based, prospective cohort study was undertaken of patients referred to our specialist MDT between 2015 and 2019. Data were collected on patients and disease characteristics including performance status, Charlson Comorbidity Index, the English Index of Multiple Deprivation quintiles and MDT treatment decision. Curative treatment was defined as neoadjuvant treatment and surgical resection that would achieve a R0 resection, and/or complete treatment of distant metastatic disease. Palliative treatment was defined as non-surgical treatment. RESULTS In total, 325 patients were identified; 72.7% of patients with LARC and 63.6% of patients with LRRC were offered treatment with curative intent (p = 0.08). Patients with poor performance status (PS > 2; p < 0.001), severe comorbidity (p < 0.001), socio-economic deprivation (p = 0.004), a positive predictive circumferential resection margin (p = 0.005) and metastatic disease (p < 0.001) were associated with palliative treatment. Overall survival in the curative cohort was 49 months (95% confidence interval [CI] 32.4-65.5) compared with 12 months (95% CI 9.1-14.9) in the palliative cohort (p < 0.001). The presence of metastatic disease was identified as a prognostic factor for patients undergoing curative treatment (p = 0.05). The only prognostic factor identified in patients treated palliatively was performance status (p < 0.001). CONCLUSIONS Our study identifies a number of preoperative, prognostic factors that affect MDT decision-making and overall survival.
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Affiliation(s)
| | | | | | | | | | - A Sharpe
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - P Coyne
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - B Griffiths
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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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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Robinson M, O'Cathail S, Duffton A, Aitken K, Muirhead R. Potential for Isotoxic Re-irradiation Stereotactic Ablative Body Radiotherapy in Locally Recurrent Rectal Cancer. Clin Oncol (R Coll Radiol) 2022; 34:571-577. [DOI: 10.1016/j.clon.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/17/2021] [Accepted: 04/13/2022] [Indexed: 12/25/2022]
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Abstract
The management of localized rectal cancer requires a multidisciplinary approach to optimize outcomes, reduce morbidity and prevent under or overtreatments. While early stages may obtain benefit of local resections without any additional therapies, locally advanced rectal cancer becomes a challenge defining the better sequential strategy of surgery, radiotherapy and chemotherapy. The latest results of international phase III studies have positioned the total neoadjuvant therapy as a potential new standard of care in high risk rectal cancers, however, the best schedule is still not well defined.
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Chung SY, Takiyama H, Kang JH, Chang JS, Min BS, Tsuji H, Yamada S, Koom WS. Comparison of clinical outcomes between carbon ion radiotherapy and X-ray radiotherapy for reirradiation in locoregional recurrence of rectal cancer. Sci Rep 2022; 12:1845. [PMID: 35115612 PMCID: PMC8813922 DOI: 10.1038/s41598-022-05809-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/13/2022] [Indexed: 02/02/2023] Open
Abstract
Carbon ion radiotherapy (CIRT) has garnered interest for the treatment of locoregional rectal cancer recurrence. No study has compared CIRT and X-ray radiotherapy (XRT) for reirradiation (reRT) in such cases. We analyzed and compared the clinical outcomes such as local control, overall survival, and late toxicity rate between CIRT and XRT, for treating locoregional rectal cancer recurrence. Patients with rectal cancer who received reRT to the pelvis by CIRT or XRT from March 2005 to July 2019 were included. The CIRT treatment schedule was 70.4 Gy (relative biological effectiveness) in 16 fractions. For the XRT group, the median reRT dose was 50 Gy (range 25-62.5 Gy) with a median of 25 fractions (range 3-33). Thirty-five and 31 patients received CIRT and XRT, respectively. Tumour and treatment characteristics such as recurrence location and chemotherapy treatment differed between the two groups. CIRT showed better control of local recurrence (adjusted hazard ratio [HR] 0.17; p = 0.002), better overall survival (HR 0.30; p = 0.004), and lower severe late toxicity rate (HR 0.15; p = 0.015) than XRT. CIRT was effective for treating locoregional rectal cancer recurrence, with high rates of local control and survival, and a low late severe toxicity rate.
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Affiliation(s)
- Seung Yeun Chung
- Department of Radiation Oncology, Yonsei Colorectal Cancer Clinic, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Hirotoshi Takiyama
- Department of Radiation Oncology, QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inageku, Chiba, 263-8555, Japan
| | - Jae Hyun Kang
- Department of Surgery, Yonsei Colorectal Cancer Clinic, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Colorectal Cancer Clinic, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Byung Soh Min
- Department of Surgery, Yonsei Colorectal Cancer Clinic, Yonsei University College of Medicine, Seoul, Korea
| | - Hiroshi Tsuji
- Department of Radiation Oncology, QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inageku, Chiba, 263-8555, Japan
| | - Shigeru Yamada
- Department of Radiation Oncology, QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inageku, Chiba, 263-8555, Japan.
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Colorectal Cancer Clinic, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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Johnson GGRJ, Yip B, Helewa RM, Shariff F, Hyun E. Rectal Cancer Metastasis to the Anal Verge: An Unusual Case Presentation and Review of the Literature. Int Med Case Rep J 2022; 15:1-6. [PMID: 35027849 PMCID: PMC8749046 DOI: 10.2147/imcrj.s350999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Anal metastasis of colorectal adenocarcinoma is very rare, represented by only a handful of case reports in the literature. Previously, reports of metastasis to this region had occurred following a history of anorectal disease, such as anal fistulae. Antecedent trauma to the area from hemorrhoidectomy, fissures, or perineal retractor injury have also been implicated. Case Presentation Herein we report the case of 69-year-old man without any history of anal disease presenting with a metachronous metastasis of a colorectal-type adenocarcinoma to the anal verge. He was previously treated for T1N0 rectal adenocarcinoma at the rectosigmoid junction with a low anterior resection 5 years prior, then had a T3N0 local recurrence at the colorectal anastomosis treated with neoadjuvant chemoradiation, and eventually a Hartmann's procedure 4 years later. Subsequently, on surveillance flexible sigmoidoscopy, a new tumor was identified on the perianal skin extending from the anal verge. Histopathology demonstrated colorectal-type adenocarcinoma. Flexible endoscopy identified no other residual or recurrent disease in the colon or rectal stump. The patient was treated with wide local excision and advancement flap reconstruction. Conclusion Isolated metastasis to the anus is an extremely rare occurrence for colorectal adenocarcinoma. There exists little evidence to inform management. One option is to treat like a locally recurrent rectal cancer with aggressive tri-modality management consisting of chemoradiation, abdominal perineal resection, and adjuvant chemotherapy. In the absence of metastatic disease, local resection and close surveillance remain an option. As always, patient factors should guide management.
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Affiliation(s)
- Garrett G R J Johnson
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Clinician Investigator Program, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Benson Yip
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ramzi M Helewa
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Farhana Shariff
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric Hyun
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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OUP accepted manuscript. Br J Surg 2022; 109:623-631. [DOI: 10.1093/bjs/znac083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022]
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Durante M, Debus J, Loeffler JS. Physics and biomedical challenges of cancer therapy with accelerated heavy ions. NATURE REVIEWS. PHYSICS 2021; 3:777-790. [PMID: 34870097 PMCID: PMC7612063 DOI: 10.1038/s42254-021-00368-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Radiotherapy should have low toxicity in the entrance channel (normal tissue) and be very effective in cell killing in the target region (tumour). In this regard, ions heavier than protons have both physical and radiobiological advantages over conventional X-rays. Carbon ions represent an excellent combination of physical and biological advantages. There are a dozen carbon-ion clinical centres in Europe and Asia, and more under construction or at the planning stage, including the first in the USA. Clinical results from Japan and Germany are promising, but a heated debate on the cost-effectiveness is ongoing in the clinical community, owing to the larger footprint and greater expense of heavy ion facilities compared with proton therapy centres. We review here the physical basis and the clinical data with carbon ions and the use of different ions, such as helium and oxygen. Research towards smaller and cheaper machines with more effective beam delivery is necessary to make particle therapy affordable. The potential of heavy ions has not been fully exploited in clinics and, rather than there being a single 'silver bullet', different particles and their combination can provide a breakthrough in radiotherapy treatments in specific cases.
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Affiliation(s)
- Marco Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Institute of Condensed Matter Physics, Technische Universität Darmstadt, Darmstadt, Germany
| | - Jürgen Debus
- Department of Radiation Oncology and Heidelberg Ion Beam Therapy Center, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jay S. Loeffler
- Departments of Radiation Oncology and Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Rønde HS, Kallehauge JF, Kronborg CJS, Nyvang L, Rekstad BL, Hanekamp BA, Appelt AL, Guren MG, Spindler KLS. Intensity modulated proton therapy planning study for organ at risk sparing in rectal cancer re-irradiation. Acta Oncol 2021; 60:1436-1439. [PMID: 34264785 DOI: 10.1080/0284186x.2021.1953139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Affiliation(s)
- H S Rønde
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - J F Kallehauge
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - C J S Kronborg
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - L Nyvang
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - B L Rekstad
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - B A Hanekamp
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - A L Appelt
- Leeds Cancer Centre, St James's University Hospital, and Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - M G Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - K L S Spindler
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Marref I, Romain G, Jooste V, Vendrely V, Lopez A, Faivre J, Gerard JP, Bouvier AM, Lepage C. Outcomes of anus squamous cell carcinoma. Management of anus squamous cell carcinoma and recurrences. Dig Liver Dis 2021; 53:1492-1498. [PMID: 34193366 DOI: 10.1016/j.dld.2021.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Little is known about the management of squamous cell carcinoma of the anal canal and its recurrence at a population level. The aim of this study was to draw a picture of management, recurrence and survival in squamous cell carcinoma of the anal canal. MATERIAL AND METHODS The 5-year probability of recurrences was estimated using the cumulative incidence function to consider competing risks of death. Net survival was estimated and a multivariate survival analysis was performed. The study was conducted using data of the Burgundy Digestive Cancer Registry. Overall, 273 squamous cell carcinomas of the anal canal registered between 1998 and 2014 were considered. RESULTS Overall, 80% of patients were treated with curative intent. Of these, 61% received chemoradiotherapy, 35% received radiotherapy and 4% received abdominoperineal resection alone. After these treatments, for cure the 5-year cumulative recurrence rate was 27% overall; it was 20% after chemoradiotherapy and 38% after radiotherapy. Five-year net survival was 71% overall; it was 81% after chemoradiotherapy and 55% after radiotherapy. CONCLUSIONS AND RELEVANCE Chemoradiotherapy was highly effective in routine practice. We confirm that it is difficult to distinguish between persistent active disease and local inflammation due to radiotherapy. Squamous cell carcinoma of the anal canal recurrences remains a substantial problem, highlighting the interest of prolonged surveillance. Aggressive management of recurrences may be beneficial.
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Affiliation(s)
- Imène Marref
- Digestive Cancer Registry of Burgundy, INSERM UMR 1231 EPICAD, University of Bourgogne-Franche Comté, University Hospital of Dijon, Dijon, France
| | - Gaëlle Romain
- Digestive Cancer Registry of Burgundy, INSERM UMR 1231 EPICAD, University of Bourgogne-Franche Comté, University Hospital of Dijon, Dijon, France
| | - Valerie Jooste
- Digestive Cancer Registry of Burgundy, INSERM UMR 1231 EPICAD, University of Bourgogne-Franche Comté, University Hospital of Dijon, Dijon, France
| | - Véronique Vendrely
- CHU de Bordeaux, Haut-Lévêque Hospital, Department of Radiotherapy, Pessac, 33604, France
| | - Anthony Lopez
- Gastroenterology and Hepatology Department, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Jean Faivre
- Digestive Cancer Registry of Burgundy, INSERM UMR 1231 EPICAD, University of Bourgogne-Franche Comté, University Hospital of Dijon, Dijon, France
| | | | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, INSERM UMR 1231 EPICAD, University of Bourgogne-Franche Comté, University Hospital of Dijon, Dijon, France
| | - Côme Lepage
- Digestive Cancer Registry of Burgundy, INSERM UMR 1231 EPICAD, University of Bourgogne-Franche Comté, University Hospital of Dijon, Dijon, France; CHU de Bordeaux, Haut-Lévêque Hospital, Department of Radiotherapy, Pessac, 33604, France; Gastroenterology and Hepatology Department, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre-lès-Nancy, France; Department of Radiotherapy, Centre A Lacassagne, Nice, France; Department of Hepatogastroenterology and Digestive Oncology and Gastroenterology, , University Hospital of Dijon, University of Bourgogne-Franche Comté, 14 Rue Paul Gaffarel, 21000 Dijon, France.
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Fok M, Toh S, Easow J, Fowler H, Clifford R, Parsons J, Vimalachandran D. Proton beam therapy in rectal cancer: A systematic review and meta-analysis. Surg Oncol 2021; 38:101638. [PMID: 34340196 DOI: 10.1016/j.suronc.2021.101638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/09/2021] [Accepted: 07/24/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Locally advanced rectal cancer is often treated with neoadjuvant chemoradiotherapy and surgery. Radiotherapy carries significant risk of toxicity to organs at risk (OAR). Proton beam therapy (PBT) has demonstrated to be effective in other cancers, delivering equivalent dosimetric radiation but with the benefit of improved sparing of OAR. This review compares dosimetric irradiation of OAR and oncological outcomes for PBT versus conventional photon-based radiotherapy in locally advanced rectal cancer. METHODS An electronic literature search was performed for studies with comparative cohorts receiving proton beam therapy and photon-based radiotherapy for rectal cancer. RESULTS Eight articles with a total of 127 patients met the inclusion criteria. There was significantly less irradiated small bowel with PBT compared to three-dimensional conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT) (MD -17.01, CI [-24.06, -9.96], p < 0.00001 and MD -6.96, CI [-12.99, -0.94], p = 0.02, respectively). Similar dosimetric results were observed for bladder and pelvic bone marrow. Three studies reported clinical and oncological results for PBT in recurrent rectal cancer with overall survival reported as 43 %, 68 % and 77.2 %, and one study in primary rectal cancer with 100 % disease free survival. CONCLUSION PBT treatment plans revealed significantly less irradiation of OAR for rectal cancer compared to conventional photon-based radiotherapy. Trials for recurrent rectal cancer and PBT have shown promising results. There are currently no ongoing clinical trials for primary rectal cancer and PBT. More research is required to validate its potential role in dose escalation, higher complete response rate and organ preservation without increasing toxicity.
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Affiliation(s)
- Matthew Fok
- Department of Colorectal Surgery, Countess of Chester NHS Foundation Trust, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK
| | - Steven Toh
- School of Medicine, University of Liverpool, Liverpool, L3 9TA, UK
| | - Jeremy Easow
- School of Medicine, University of Liverpool, Liverpool, L3 9TA, UK
| | - Hayley Fowler
- Department of Colorectal Surgery, Countess of Chester NHS Foundation Trust, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK
| | - Rachael Clifford
- Department of Colorectal Surgery, Countess of Chester NHS Foundation Trust, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK
| | - Jason Parsons
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK; Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, CH63 4JY, UK
| | - Dale Vimalachandran
- Department of Colorectal Surgery, Countess of Chester NHS Foundation Trust, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK.
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Chandra RA, Keane FK, Voncken FEM, Thomas CR. Contemporary radiotherapy: present and future. Lancet 2021; 398:171-184. [PMID: 34166607 DOI: 10.1016/s0140-6736(21)00233-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/18/2020] [Accepted: 01/08/2021] [Indexed: 02/06/2023]
Abstract
Oncology care is increasingly a multidisciplinary endeavour, and radiation therapy continues to have a key role across the disease spectrum in nearly every cancer. However, the field of radiation oncology is still one of the most poorly understood of the cancer disciplines. In this Review, we attempt to summarise and contextualise developments within the field of radiation oncology for the non-radiation oncologist. We discuss advancements in treatment technologies and imaging, followed by an overview of the interplay with advancements in systemic therapy and surgical techniques. Finally, we review new frontiers in radiation oncology, including advances within the metastatic disease continuum, reirradiation, and emerging types of radiation therapy.
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Affiliation(s)
- Ravi A Chandra
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Florence K Keane
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Francine E M Voncken
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
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Denost Q, Frison E, Salut C, Sitta R, Rullier A, Harji D, Maillou-Martinaud H, Rullier E, Smith D, Vendrely V. A phase III randomized trial evaluating chemotherapy followed by pelvic reirradiation versus chemotherapy alone as preoperative treatment for locally recurrent rectal cancer - GRECCAR 15 trial protocol. Colorectal Dis 2021; 23:1909-1918. [PMID: 33843133 DOI: 10.1111/codi.15670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/14/2021] [Accepted: 03/23/2021] [Indexed: 12/16/2022]
Abstract
AIM Treatment strategies in locally recurrent rectal cancer (LRRC) are complex and need to be balanced against previous treatments received for the primary rectal cancer. Radiotherapy is an important component of treatment in LRRC. However, there is little high-quality evidence on the role of reirradiation in this cohort. Therefore, the aim of this trial is to assess the efficacy of neoadjuvant chemotherapy followed by pelvic reirradiation versus neoadjuvant chemotherapy alone on the rate of curative surgery (R0) in previously irradiated patients with LRRC. METHOD GRECCAR 15 is a prospective, multicentre, open-label, outcome assessor-blinded, superiority randomized controlled phase III clinical trial comparing neoadjuvant chemotherapy followed by pelvic reirradiation versus neoadjuvant chemotherapy alone in patients with LRRC previously irradiated for the primary cancer. Adult patients (>18 years old) with a histologically proven resectable LRRC, who have previously received pelvic radiotherapy for their primary rectal cancer at a dose of 25-50.4 Gy, and an Eastern Cooperative Oncology Group performance status of <2 will be eligible to participate. The pelvic reirradiation will consist of conformational intensity-modulated external irradiation, delivering a dose of 30.6 Gy with concomitant chemotherapy using capecitabine. The primary outcome of this trial is the R0 resection rate. Overall, GRECCAR 15 aims to recruit 186 patients to detect an absolute difference of 20% in the R0 resection rate with 80% power and 5% two-sided significance level. CONCLUSION The GRECCAR 15 trial is the first, definitive, phase III trial to investigate reirradiation in LRRC. The results of this trial will inform definitively the neoadjuvant treatment strategy in previously irradiated patients and assess whether there is any associated benefit of reirradiation in combination with induction chemotherapy in improving R0 resection rates.
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Affiliation(s)
- Quentin Denost
- Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, CHU, Bordeaux, France
| | - Eric Frison
- Inserm, CIC1401-EC, Bordeaux, Service D'information Médicale, CHU, Bordeaux, France
| | - Cécile Salut
- Service de Radiologie, Hôpital Haut-Lévèque, CHU, Bordeaux, France
| | - Remy Sitta
- Inserm, CIC1401-EC, Bordeaux, Service D'information Médicale, CHU, Bordeaux, France
| | - Anne Rullier
- Service d'Anatomopathologie, Hôpital Pellegrin, CHU, Bordeaux, France
| | - Deena Harji
- Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, CHU, Bordeaux, France
| | | | - Eric Rullier
- Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, CHU, Bordeaux, France
| | - Denis Smith
- Service D'oncologie, Hôpital Haut-Lévèque, CHU, Bordeaux, France
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Induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as neoadjuvant treatment for locally recurrent rectal cancer: study protocol of a multicentre, open-label, parallel-arms, randomized controlled study (PelvEx II). BJS Open 2021; 5:6293963. [PMID: 34089596 PMCID: PMC8179511 DOI: 10.1093/bjsopen/zrab029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/26/2021] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background A resection with clear margins (R0 resection) is the most important prognostic factor in patients with locally recurrent rectal cancer (LRRC). However, this is achieved in only 60 per cent of patients. The aim of this study is to investigate whether the addition of induction chemotherapy to neoadjuvant chemo(re)irradiation improves the R0 resection rate in LRRC. Methods This multicentre, international, open-label, phase III, parallel-arms study will enrol 364 patients with resectable LRRC after previous partial or total mesorectal resection without synchronous distant metastases or recent chemo- and/or radiotherapy treatment. Patients will be randomized to receive either induction chemotherapy (three 3-week cycles of CAPOX (capecitabine, oxaliplatin), four 2-week cycles of FOLFOX (5-fluorouracil, leucovorin, oxaliplatin) or FOLFORI (5-fluorouracil, leucovorin, irinotecan)) followed by neoadjuvant chemoradiotherapy and surgery (experimental arm) or neoadjuvant chemoradiotherapy and surgery alone (control arm). Tumours will be restaged using MRI and, in the experimental arm, a further cycle of CAPOX or two cycles of FOLFOX/FOLFIRI will be administered before chemoradiotherapy in case of stable or responsive disease. The radiotherapy dose will be 25 × 2.0 Gy or 28 × 1.8 Gy in radiotherapy-naive patients, and 15 × 2.0 Gy in previously irradiated patients. The concomitant chemotherapy agent will be capecitabine administered twice daily at a dose of 825 mg/m2 on radiotherapy days. The primary endpoint of the study is the R0 resection rate. Secondary endpoints are long-term oncological outcomes, radiological and pathological response, toxicity, postoperative complications, costs, and quality of life. Discussion This trial protocol describes the PelvEx II study. PelvEx II, designed as a multicentre, open-label, phase III, parallel-arms study, is the first randomized study to compare induction chemotherapy followed by neoadjuvant chemo(re)irradiation and surgery with neoadjuvant chemo(re)irradiation and surgery alone in patients with locally recurrent rectal cancer, with the aim of improving the number of R0 resections.
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Gao Z, Gu J. Surgical treatment of locally recurrent rectal cancer: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1026. [PMID: 34277826 PMCID: PMC8267292 DOI: 10.21037/atm-21-2298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022]
Abstract
Objective To summarize the recent literature on surgical treatment of locally recurrent rectal cancer (LRRC). Background LRRC is a heterogeneous disease that requires a multidisciplinary treatment approach. The treatment and prognosis depend on the site and type of recurrence. Radical resection remains the primary method for achieving long-term survival and improving symptom control. Preoperative chemoradiotherapy can reduce tumor volume and improve the R0 resection rate. Surgeons must clearly understand pelvic anatomy, develop a detailed preoperative plan, adopt a multidisciplinary approach for the surgical resection of the tumor as well as any invaded soft tissues, vessels, and bones, and ensure proper reconstruction. However, extended radical surgery often leads to a higher risk of postoperative complications and a low quality of life. Methods We searched English-language articles with keywords “locally recurrent rectal cancer”, “surgery” and “multidisciplinary team” in PubMed published between January 2000 to October 2020. Conclusions LRRC is a complex problem. Long-term survival is not impossible following multidisciplinary treatment in appropriately selected LRRC patients. The management of LRRC relies on a specialist team that determines the biological behavior of the tumor and evaluates treatment options through multidisciplinary discussions, thereby balancing the surgical costs and benefits, alleviating postoperative complications, and improving patients’ quality of life.
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Affiliation(s)
- Zhaoya Gao
- Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing, China
| | - Jin Gu
- Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing, China.,Department of Gastrointestinal Surgery III, Peking University Cancer Hospital, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
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Romesser PB, Crane CH. Chemo-Re-Irradiation and Salvage Surgery for Locally Recurrent Rectal Cancer. Ann Surg Oncol 2021; 28:4769-4771. [PMID: 34031771 DOI: 10.1245/s10434-021-10198-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Paul B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Christopher H Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Dijkstra EA, Mul VEM, Hemmer PHJ, Havenga K, Hospers GAP, Muijs CT, van Etten B. Re-Irradiation in Patients with Recurrent Rectal Cancer is Safe and Feasible. Ann Surg Oncol 2021; 28:5194-5204. [PMID: 34023946 PMCID: PMC8349344 DOI: 10.1245/s10434-021-10070-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is no consensus yet for the best treatment regimen in patients with recurrent rectal cancer (RRC). This study aims to evaluate toxicity and oncological outcomes after re-irradiation in patients with RRC in our center. Clinical (cCR) and pathological complete response (pCR) rates and radicality were also studied. METHODS Between January 2010 and December 2018, 61 locally advanced RRC patients were treated and analyzed retrospectively. Patients received radiotherapy at a dose of 30.0-30.6 Gy (reCRT) or 50.0-50.4 Gy chemoradiotherapy (CRT) in cases of no prior irradiation because of low-risk primary rectal cancer. In both groups, patients received capecitabine concomitantly. RESULTS In total, 60 patients received the prescribed neoadjuvant (chemo)radiotherapy followed by surgery, 35 patients (58.3%) in the reRCT group and 25 patients (41.7%) in the long-course CRT group. There were no significant differences in overall survival (p = 0.82), disease-free survival (p = 0.63), and local recurrence-free survival (p = 0.17) between the groups. Patients in the long-course CRT group reported more skin toxicity after radiotherapy (p = 0.040). No differences were observed in late toxicity. In the long-course CRT group, a significantly higher cCR rate was observed (p = 0.029); however, there was no difference in the pCR rate (p = 0.66). CONCLUSIONS The treatment of RRC patients with re-irradiation is comparable to treatment with long-course CRT regarding toxicity and oncological outcomes. In the reCRT group, less cCR was observed, although there was no difference in pCR. The findings in this study suggest that it is safe and feasible to re-irradiate RRC patients.
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Affiliation(s)
- Esmée A Dijkstra
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Véronique E M Mul
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Patrick H J Hemmer
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaas Havenga
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Boudewijn van Etten
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Wang H, Peng R, Li X, Wang Y, Jiang Y, Ji Z, Guo F, Tian S, Sun H, Fan J, Wang J. The dosimetry evaluation of 3D printing non-coplanar template-assisted CT-guided 125I seed stereotactic ablation brachytherapy for pelvic recurrent rectal cancer after external beam radiotherapy. JOURNAL OF RADIATION RESEARCH 2021; 62:473-482. [PMID: 33616168 PMCID: PMC8127672 DOI: 10.1093/jrr/rraa144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/14/2020] [Indexed: 06/12/2023]
Abstract
The aim of this study was to investigate the safety and accuracy of computed tomography (CT)-guided 125I seed implantation assisted by a three-dimensional printing non-coplanar template (3D-PNCT) for treating pelvic locally recurrent rectal cancer (LRRC) patients. A total of 13 patients with 18 masses received 125I seed implantation. The dosimetric parameters of pre-implantation and post-implantation were calculated to evaluate the quality of 125I seed implantation. Doses delivered to the organs at risk (OAR) were also calculated. Differences between pre-implantation and post-implantation were compared by the paired t-test. The mean number of 125I seeds pre-implantation and post-implantation was 67.1 and 68.8, respectively. The mean values of D90 (dose that was delivered to 90% of the target volume), D100 (dose that was delivered to 100% of the target volume), V100 (the target volume receiving 100% of the prescription dose) and V150 (the target volume receiving 150% of the prescription dose) pre-implantation and post-implantation were 136.6 and 135.2 Gy, 63.5 and 71.0 Gy, 90.3% and 90.3% and 62.1% and 62.2%, respectively. Dosimetric outcomes were evaluated quantitatively using the dose volume indices, i.e. coverage index (CI), external volume index (EI) and relative dose homogeneity index (HI). The mean values of those indices pre-implantation and post-implantation were 0.62 and 0.61, 0.31 and 0.33, and 0.31 and 0.31, respectively. The mean doses delivered to OAR pre-implantation and post-implantation for the bladder (D2cc) and bowel (D2cc) were 33.4 and 34.4 Gy, and 58.6 and 61.8 Gy, respectively. The parameters mentioned above fitted well, and no significant difference was found among them. It is concluded that CT-guided 125I seed implantation assisted by 3D-PNCT could be a safe and accurate salvage modality for treating LRRC patients; the ideal pre-prescription dose could be achieved. Also, addition of 3D-PNCT could minimize radiation damage to the surrounding normal tissues.
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Affiliation(s)
- Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49th Huayuan North Street, Haidian District, Beijing, China, 100191
| | - Ran Peng
- Department of Radiation Oncology, Peking University Third Hospital, 49th Huayuan North Street, Haidian District, Beijing, China, 100191
| | - Xuemin Li
- Department of Radiation Oncology, Peking University Third Hospital, 49th Huayuan North Street, Haidian District, Beijing, China, 100191
| | - Yuxia Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49th Huayuan North Street, Haidian District, Beijing, China, 100191
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, 49th Huayuan North Street, Haidian District, Beijing, China, 100191
| | - Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, 49th Huayuan North Street, Haidian District, Beijing, China, 100191
| | - Fuxin Guo
- Department of Radiation Oncology, Peking University Third Hospital, 49th Huayuan North Street, Haidian District, Beijing, China, 100191
| | - Suqing Tian
- Department of Radiation Oncology, Peking University Third Hospital, 49th Huayuan North Street, Haidian District, Beijing, China, 100191
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, 49th Huayuan North Street, Haidian District, Beijing, China, 100191
| | - Jinghong Fan
- Department of Radiation Oncology, Peking University Third Hospital, 49th Huayuan North Street, Haidian District, Beijing, China, 100191
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49th Huayuan North Street, Haidian District, Beijing, China, 100191
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Miller JA, Wang H, Chang DT, Pollom EL. Cost-Effectiveness and Quality-Adjusted Survival of Watch and Wait After Complete Response to Chemoradiotherapy for Rectal Cancer. J Natl Cancer Inst 2021; 112:792-801. [PMID: 31930400 DOI: 10.1093/jnci/djaa003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision (TME) is the standard treatment for locally advanced rectal cancer. There is interest in deescalating local therapy after a clinical complete response to CRT. We hypothesized that a watch-and-wait (WW) strategy offers comparable cancer-specific survival, superior quality-adjusted survival, and reduced cost compared with upfront TME. METHODS We developed a decision-analytic model to compare WW, low anterior resection, and abdominoperineal resection for patients achieving a clinical complete response to CRT. Rates of local regrowth, pelvic recurrence, and distant metastasis were derived from series comparing WW with TME after pathologic complete response. Lifetime incremental costs and quality-adjusted life-years (QALY) were calculated between strategies, and sensitivity analyses were performed to study model uncertainty. RESULTS The base case 5-year cancer-specific survival was 93.5% (95% confidence interval [CI] = 91.5% to 94.9%) on a WW program compared with 95.9% (95% CI = 93.6% to 97.4%) after upfront TME. WW was dominant relative to low anterior resection, with cost savings of $28 500 (95% CI = $22 200 to $39 000) and incremental QALY of 0.527 (95% CI = 0.138 to 1.125). WW was also dominant relative to abdominoperineal resection, with a cost savings of $32 100 (95% CI = $21 800 to $49 200) and incremental QALY of 0.601 (95% CI = 0.213 to 1.208). WW remained dominant in sensitivity analysis unless the rate of surgical salvage fell to 73.0%. CONCLUSIONS Using current multi-institutional recurrence estimates, we observed comparable cancer-specific survival, superior quality-adjusted survival, and decreased costs with WW compared with upfront TME. Upfront TME was preferred when surgical salvage rates were low.
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Affiliation(s)
- Jacob A Miller
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Hannah Wang
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
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Gani C, Lamprecht U, Ziegler A, Moll M, Gellermann J, Heinrich V, Wenz S, Fend F, Königsrainer A, Bitzer M, Zips D. Deep regional hyperthermia with preoperative radiochemotherapy in locally advanced rectal cancer, a prospective phase II trial. Radiother Oncol 2021; 159:155-160. [PMID: 33741467 DOI: 10.1016/j.radonc.2021.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE The goal of the present study was to investigate the effect of deep regional hyperthermia on early and long-term oncological outcomes in the context of preoperative radiochemotherapy in rectal cancer. METHODS In this prospective phase II trial, patients with locally advanced rectal cancer were treated with 5-fluorouracil based preoperative radiochemotherapy with 50.4 Gy in 28 fractions. Deep regional hyperthermia was scheduled twice weekly. Pathological tumor regression was scored according to the Dworak regression system. The primary endpoint was pathological complete response (pCR). Further endpoints were local control (LC), distant control (DC), disease-free survival (DFS) and overall survival (OS). Hyperthermia was defined as feasible if 70% of patients received at least eight treatments. Quality of life was assessed at follow-up by the EORTC-QLQ-C30 and QLQ-CR29 questionnaires. Time to event data was analyzed according to Kaplan-Meier based on first-events. The study was registered on clinicaltrials.gov (NCT02353858). RESULTS From 2012 until 2017, 78 patients were recruited. Median follow-up was 54 months. Based on magnetic resonance imaging, the mesorectal fascia was involved or threatened in 60% of the patients. Compliance with radiotherapy was 99%, 91% received both cycles of chemotherapy and 77% had eight or more hyperthermia treatments. Median time from the end of radiotherapy to surgery was 6.7 weeks. A pathological complete response was reported in 14% of the patients, 50% had either Dworak 4 (complete regression) or Dworak 3 regression (scattered tumor cells only). Three year estimates for OS, DFS, LC and DC were 94%, 81%, 96% and 87%. Patients with higher hyperthermia related cumulative temperatures showed stronger tumor regression. Global health status based on EORTC-QLQ-C30 was comparable with data from the general population. CONCLUSION Deep regional hyperthermia was feasible, did not compromise standard treatments and resulted in promising long-term oncological outcomes and QoL.
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Affiliation(s)
- Cihan Gani
- University Hospital Tübingen, Department of Radiation Oncology, Germany; German Cancer Research Center (DKFZ) Heidelberg and German Consortium for Translational Cancer Research (DKTK), Partner Site Tübingen, Germany.
| | - Ulf Lamprecht
- University Hospital Tübingen, Department of Radiation Oncology, Germany
| | - Alexander Ziegler
- Department of Internal Medicine, Oncology/Hematology, Gastroenterology, Hospital Esslingen GmbH, Germany
| | - Matthias Moll
- Department of Radiation Oncology, Medical University of Vienna, Wien, Austria
| | | | - Vanessa Heinrich
- University Hospital Tübingen, Department of Radiation Oncology, Germany
| | - Svetlana Wenz
- Institute of Pathology and Neuropathology, Eberhard-Karls University, Tuebingen, Germany
| | - Falko Fend
- German Cancer Research Center (DKFZ) Heidelberg and German Consortium for Translational Cancer Research (DKTK), Partner Site Tübingen, Germany; Institute of Pathology and Neuropathology, Eberhard-Karls University, Tuebingen, Germany
| | - Alfred Königsrainer
- University Hospital Tübingen, Department of General, Visceral and Transplant Surgery, Germany
| | - Michael Bitzer
- University Hospital Tübingen, Department of Internal Medicine I, Germany
| | - Daniel Zips
- University Hospital Tübingen, Department of Radiation Oncology, Germany; German Cancer Research Center (DKFZ) Heidelberg and German Consortium for Translational Cancer Research (DKTK), Partner Site Tübingen, Germany
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Neoadjuvant Chemoradiation Combined with Regional Hyperthermia in Locally Advanced or Recurrent Rectal Cancer. Cancers (Basel) 2021; 13:cancers13061279. [PMID: 33805731 PMCID: PMC8001688 DOI: 10.3390/cancers13061279] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/23/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The HyRec trial was initially designed to optimize and standardize the treatment of locally recurrent rectal cancer (LRRC). An escalated neoadjuvant treatment schedule, consisting of curative radiotherapy, concurrent chemotherapy with 5-Fluorouracil and Oxaliplatin, and additional regional hyperthermia, was evaluated with the intention to increase the rate of curative resections. Primary endpoints were the feasibility rate defined by the number of therapy-limiting toxicity or treatment withdrawal, and the pathologically confirmed complete remission (pCR) rate. Between 2012 and 2018, 111 patients with Union for International Cancer Control (UICC) stage IIB-IV or any locally recurrent rectal cancer were included. The intensified neoadjuvant and multimodality treatment schedule was feasible and led to comparable early toxicity rates as described by other trials that used the similar chemoradiation protocol. The presented treatment regimen resulted in a very high pCR rate and appears as a promising option for patients with LRRC. Abstract Background: To prospectively analyze feasibility and pathological complete response (pCR) rates of neoadjuvant chemoradiotherapy combined with regional hyperthermia (RHT) in patients with locally advanced (LARC) or recurrent (LRRC) rectal cancer. Methods: between 2012 and 2018, 111 patients with UICC stage IIB-IV or any locally recurrent rectal cancer were included (HyRec-Trial, ClinicalTrials.gov Identifier: NCT01716949). Patients received radiotherapy with concurrent 5-Fluororuracil (5-FU)/Capecitabine and Oxaliplatin, and RHT. Stage 1 feasibility analysis evaluated dose-limiting toxicities (DLT) after 19 patients, stage 2 after 59 evaluable patients. Analysis of the pCR rate was based on histopathological reports. Results: the feasibility rates for stages 1 and 2 were 90% (17/19) and 73% (43/59), respectively. In the intention-to-treat population the pCR rate was 19% (20/105; 90% confidence interval (CI) 13.0–26.5). In the per-protocol-analysis, complete tumor regression was seen in 28% (18/64) and 38% (3/8) of the patients with LARC and LRRC, respectively. Complete resection rates (R0) among patients with LARC and LRRC who received surgery were 99% (78/84) and 67% (8/12). Conclusions: the intensified neoadjuvant and multimodality treatment schedule was feasible and led to comparable early toxicity rates as described by other trials that used the similar chemoradiation protocol. The presented treatment regimen resulted in a very high pCR rate and appears as a promising option for patients with LRRC.
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Wang H, Wang L, Jiang Y, Ji Z, Guo F, Jiang P, Li X, Chen Y, Sun H, Fan J, Du G, Wang J. Long-Term Outcomes and Prognostic Analysis of Computed Tomography-Guided Radioactive 125I Seed Implantation for Locally Recurrent Rectal Cancer After External Beam Radiotherapy or Surgery. Front Oncol 2021; 10:540096. [PMID: 33552943 PMCID: PMC7859443 DOI: 10.3389/fonc.2020.540096] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 12/04/2020] [Indexed: 01/04/2023] Open
Abstract
Background Management of locally recurrent rectal cancer (LRRC) after surgery or external beam radiotherapy (EBRT) remains a clinical challenge, given the limited treatment options and unsatisfactory outcomes. This study aimed to assess long-term outcomes of computed tomography (CT)-guided radioactive 125I seed implantation in patients with LRRC and associated prognostic factors. Methods A total of 101 patients with LRRC treated with CT-guided 125I seed implantation from October 2003 to April 2019 were retrospectively studied. Treatment procedures involved preoperative planning design, 125I seed implantation, and postoperative dose evaluation. We evaluated the therapeutic efficacy, adverse effects, local control (LC) time, and overall survival (OS) time. Results All the patients had previously undergone surgery or EBRT. The median age of patients was 59 (range, 31–81) years old. The median follow-up time was 20.5 (range, 0.89–125.8) months. The median LC and OS time were 10 (95% confidence interval (CI): 8.5–11.5) and 20.8 (95% CI: 18.7–22.9) months, respectively. The 1-, 2-, and 5-year LC rates were 44.2%, 20.7%, and 18.4%, respectively. The 1-, 2-, and 5-year OS rates were 73%, 31.4%, and 5%, respectively. Univariate analysis of LC suggested that when short-time tumor response achieved partial response (PR) or complete response (CR), or D90>129 Gy, or GTV ≤ 50 cm3, the LC significantly prolonged (P=0.044, 0.041, and <0.001, respectively). The multivariate analysis of LC indicated that the short-time tumor response was an independent factor influencing LC time (P<0.001). Besides, 8.9% (9/101) of the patients had adverse effects (≥grade 3): radiation-induced skin reaction (4/101), radiation-induced urinary reaction (1/101), fistula (2/101), and intestinal obstruction (2/101). The cumulative irradiation dose and the activity of a single seed were significantly correlated with adverse effects ≥grade 3 (P=0.047 and 0.035, respectively). Conclusion CT-guided 125I seed implantation is a safe and effective salvage treatment for LRRC patients who previously underwent EBRT or surgery. D90 and GTV significantly influenced prognosis of such patients.
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Affiliation(s)
- Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Lu Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Fuxin Guo
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Xuemin Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yi Chen
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Jinghong Fan
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Gang Du
- Department of Radiation Oncology, Bayannur Hospital, Bayannur, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
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Sorrentino L, Belli F, Valvo F, Villa S, Guaglio M, Scaramuzza D, Gronchi A, Di Bartolomeo M, Cosimelli M. Neoadjuvant (re)chemoradiation for locally recurrent rectal cancer: Impact of anatomical site of pelvic recurrence on long-term results. Surg Oncol 2020; 35:89-96. [DOI: 10.1016/j.suronc.2020.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/23/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022]
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Koroulakis A, Molitoris J, Kaiser A, Hanna N, Bafford A, Jiang Y, Bentzen S, Regine WF. Reirradiation for Rectal Cancer Using Pencil Beam Scanning Proton Therapy: A Single Institutional Experience. Adv Radiat Oncol 2020; 6:100595. [PMID: 33490730 PMCID: PMC7807140 DOI: 10.1016/j.adro.2020.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose Reirradiation for rectal cancer (RC) after prior pelvic radiation therapy (RT) has been shown to be safe and effective. However, limited data exist for proton therapy (PT), including pencil beam scanning proton therapy (PBS-PT). We hypothesize that PT is safe and feasible for re-treatment and may allow for decreased toxicity and treatment escalation. Methods and materials A single-institution, retrospective, institutional review board–approved analysis of all patients with RC and prior pelvic RT receiving PBS-PT reirradiation was performed. Data on patient and treatment characteristics and outcomes were collected. Local progression, progression-free survival, overall survival, and late grade >3 toxicity were estimated using the Kaplan-Meier method. Results Twenty-eight patients (median follow-up: 28.6 months) received PBS-PT reirradiation between 2016 and 2019, including 18 patients with recurrent RC (median prior dose: 54.0 Gy) and 10 patients with de novo RC and variable prior RT. The median reirradiation dose was 44.4 Gy (range, 16.0-60.0 Gy; 21 of 28 twice daily), and 24 of 28 patients received concurrent chemotherapy. Six underwent surgical resection. Three (10.7%) experienced grade 3 acute toxicities, and 1 did not complete RT owing to toxicity. Four (14.2%) had late grade <3 toxicity, including 1 grade 5 toxicity in a patient with a prior RT-related injury. The 1-year local progression, progression-free survival, and overall survival rates were 33.7% (95% confidence interval [CI], 14.5%-52.9%), 45.0% (95% CI, 26.2%-63.8%), and 81.8% (95% CI, 67.3%-96.3%), respectively. Conclusions This is the largest series using PT for reirradiation for RC and the first study using PBS-PT. Low acute toxicity rates and acceptable late toxicity support PBS-PT as an option for this high-risk patient population, with a need for continued follow-up.
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Affiliation(s)
- Antony Koroulakis
- University of Maryland Medical Center, Radiation Oncology, Baltimore, Maryland
| | - Jason Molitoris
- University of Maryland School of Medicine, Radiation Oncology, Baltimore, Maryland
| | - Adeel Kaiser
- University of Maryland School of Medicine, Radiation Oncology, Baltimore, Maryland
| | - Nader Hanna
- University of Maryland School of Medicine, Surgical Oncology, Baltimore, Maryland
| | - Andrea Bafford
- University of Maryland School of Medicine, Surgical Oncology, Baltimore, Maryland
| | - Yixing Jiang
- University of Maryland School of Medicine, Medical Oncology, Baltimore, Maryland
| | - Søren Bentzen
- University of Maryland School of Medicine, Radiation Oncology, Baltimore, Maryland
| | - William F Regine
- University of Maryland School of Medicine, Radiation Oncology, Baltimore, Maryland
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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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Venkatesulu BP, Giridhar P, Malouf TD, Trifletti DM, Krishnan S. A systematic review of the role of carbon ion radiation therapy in recurrent rectal cancer. Acta Oncol 2020; 59:1218-1223. [PMID: 32476538 DOI: 10.1080/0284186x.2020.1769184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Colorectal cancer is the fourth leading cause of cancer-associated death in the world. The 5-year local recurrence rates in patients undergoing multimodality therapy are approximately 5-10%. The standard approach to treat locally recurrent rectal is re-irradiation followed by surgical resection. Recent reports have suggested that the treatment outcomes with carbon ion radiation therapy (CIRT) in recurrent rectal cancer are promising and have superior results compared to photon therapy. Hence, we performed a systematic review to evaluate the patterns of care and treatment outcomes of recurrent rectal cancer patients treated with CIRT. METHODOLOGY We performed a systematic search to identify the articles that reported on CIRT use in recurrent rectal cancer. RESULTS Systematic search of PubMed and Cochrane Central resulted in 98 abstracts. Eight studies fulfilled the predefined inclusion criteria. Among eight studies, one study is a prospective phase I/II study done in Japan; three prospective studies are ongoing (PANDORA-01 trial, HIMAT1351trial, and a phase II study of reirradiation for prior CIRT), and five studies are institutional reports on role of CIRT. These studies were predominantly reported from Japan and Germany. All reports except one were performed in patients who have not received prior radiation. The most commonly utilized treatment prescription was 73.4 Gy (RBE) in 16 fractions over 4 weeks in patients without any prior history of radiation and 36 Gy in 12 fractions over 3 weeks at 3 Gy per fraction in patients with prior photon radiation to the pelvis. There is one ongoing trial assessing the role of carbon ion re-irradiation in patients who had prior CIRT for rectal cancer. CONCLUSION CIRT holds immense promise in improving outcomes in locally recurrent rectal cancer. There is a need for more multi-institutional prospective clinical trials to assess the role of CIRT.
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Affiliation(s)
| | - Prashanth Giridhar
- Department of Radiation Oncology, All India Institute of medical sciences, New Delhi, India
| | - Timothy D. Malouf
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Daniel M. Trifletti
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
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Factors impacting oncologic outcomes in patients undergoing surgery for locally recurrent rectal cancer. SEMINARS IN COLON AND RECTAL SURGERY 2020. [DOI: 10.1016/j.scrs.2020.100765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Smith T, O'Cathail SM, Silverman S, Robinson M, Tsang Y, Harrison M, Hawkins MA. Stereotactic Body Radiation Therapy Reirradiation for Locally Recurrent Rectal Cancer: Outcomes and Toxicity. Adv Radiat Oncol 2020; 5:1311-1319. [PMID: 33305093 PMCID: PMC7718547 DOI: 10.1016/j.adro.2020.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) has emerged as a potential therapeutic option for locally recurrent rectal cancer (LRRC) but contemporaneous clinical data are limited. We aimed to evaluate the local control, toxicity, and survival outcomes in a cohort of patients previously treated with neoadjuvant pelvic radiation therapy for nonmetastatic locally recurrent rectal cancer, now treated with SBRT. Methods and Materials Inoperable rectal cancer patients with ≤3 sites of pelvic recurrence and >6 months since prior pelvic radiation therapy were identified from a prospective registry over 4 years. SBRT dose was 30 Gy in 5 fractions, daily or alternate days, using cumulative organ at risk dose constraints. Primary outcome was local control (LC). Secondary outcomes were progression free survival, overall survival, toxicity, and patient reported quality of life scores using the EQ visual analog scale (EQ-VAS) tool. Results Thirty patients (35 targets) were included. Median gross tumor volume size was 14.3 cm3. In addition, 27 of 30 (90%) previously received 45 to 50.4 Gy in 25 of 28 fractions, with 10% receiving an alternative prescription. All patients received the planned reirradiation SBRT dose. The median follow-up was 24.5 months (interquartile range, 17.8-28.8). The 1-year LC was 84.9% (95% confidence interval [CI], 70.6-99) and a 2-year LC was 69% (95% CI, 51.8-91.9). The median progression free survival was 12.1 months (95% CI, 8.6-17.66), and median overall survival was 28.3 months (95% CI, 17.88-39.5 months). No patient experienced >G2 acute toxicity and only 1 patient experienced late G3 toxicity. Patient-reported QoL outcomes were improved at 3 months after SBRT (Δ EQ-VAS, +10 points, Wilcoxon signed-rank, P = .009). Conclusions Our study demonstrates that, for small volume pelvic disease relapses from rectal cancer, reirradiation with 30 Gy in 5 fractions is well tolerated and achieves an excellent balance between high local control rates with limited toxicity.
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Affiliation(s)
- Thomas Smith
- Mount Vernon Cancer Centre, East and North Herefordshire NHS Trust, Middlesex, UK
| | - Sean M O'Cathail
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Sabrina Silverman
- Mount Vernon Cancer Centre, East and North Herefordshire NHS Trust, Middlesex, UK
| | | | - Yatman Tsang
- Mount Vernon Cancer Centre, East and North Herefordshire NHS Trust, Middlesex, UK
| | - Mark Harrison
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Maria A Hawkins
- Medical Physics and Biomedical Engineering, University College London and University, London, England, UK.,College London Hospitals NHS Foundation Trust, London, England, UK
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Wang L, Wang H, Jiang Y, Ji Z, Guo F, Jiang P, Li X, Chen Y, Sun H, Fan J, Li W, Li X, Wang J. The efficacy and dosimetry analysis of CT-guided 125I seed implantation assisted with 3D-printing non-co-planar template in locally recurrent rectal cancer. Radiat Oncol 2020; 15:179. [PMID: 32711542 PMCID: PMC7382046 DOI: 10.1186/s13014-020-01607-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 06/30/2020] [Indexed: 01/31/2023] Open
Abstract
Background Locally recurrent rectal cancer (LRRC) after surgery or external beam radiotherapy (EBRT) is a serious challenge for which no standard treatment is defined. In the present study, we investigated the feasibility of computed tomography (CT)-guided radioactive 125I seed (RIS) implantation assisted with three-dimensional printing non-coplanar template (3D-PNCT) in LRRC patients who previously received surgery or EBRT. Methods Sixty-six patients with LRRC treated by CT-guided RIS implantation in our institute from December 2015 to May 2019 were included. The treatment procedure included: preoperative CT localization, planning design, the printing of 3D individualized template, CT-guided RIS implantation assisted with 3D-PNCT, and postoperative dose evaluation. Therapeutic outcomes including local control (LC) and overall survival (OS) were retrospectively evaluated, as well as side effects. Results All the patients had previously received surgery or EBRT. The median follow-up time was 12.2 (range, 2.5–35.9) months. The median radioactive activity of a single RIS was 0.6 (range, 0.43–0.72) mCi. The median number of RIS was 60, ranging from 10 to 175. The dosimetric parameters included D90 (140.7 ± 33.1) Gy, D100 (90.3 ± 138.6) Gy, and V100 (91.0 ± 13.3) %. Pain relief was achieved in 85.1% (40/47) of patients. Besides, 9.1% (6/66) of patients had severe side effects (≥grade 3), including perianal skin ulcer in 1 case, fistula, radiation proctitis, and intestinal obstruction each in two cases. Median OS time was 14.7 (95% confidence interval (CI): 13.0–16.3) months, and median LC time was 12.2 (95% CI: 9.1–15.2) months. Univariate analysis revealed that when D90 > 130 Gy or D100 > 55 Gy or V100 > 90%, the LC time was remarkably prolonged. However, none of the parameters significantly affected OS. Conclusions CT-guided RIS implantation assisted with 3D-PNCT is an effective and safe salvage treatment strategy for patients with LRRC after EBRT or surgery. D90, D100, and V100 can be used as prognostic predictors. Trial registration NCT03890926.
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Affiliation(s)
- Lu Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Fuxin Guo
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xuemin Li
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Yi Chen
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jinghong Fan
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Weiyan Li
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xu Li
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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Al-Haidari G, Skovlund E, Undseth C, Rekstad BL, Larsen SG, Åsli LM, Dueland S, Malinen E, Guren MG. Re-irradiation for recurrent rectal cancer - a single-center experience. Acta Oncol 2020; 59:534-540. [PMID: 32056476 DOI: 10.1080/0284186x.2020.1725111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: There is no clear consensus on the use of re-irradiation (reRT) in the management of locally recurrent rectal cancer (LRRC). The aim of the present study was to investigate all reRT administered for rectal cancer at a large referral institution and to evaluate patient outcomes and toxicity.Material and methods: All patients with rectal cancer were identified who had received previous pelvic radiotherapy (RT) and underwent reRT during 2006-2016. Medical records and RT details of the primary tumor treatments and rectal cancer recurrence treatments were registered, including details on reRT, chemotherapy, surgery, adverse events, and long-term outcomes.Results: Of 77 patients who received ReRT, 67 had previously received pelvic RT for rectal cancer and were administered reRT for LRRC. Re-irradiation doses were 30.0-45.0 Gy, most often given as hyperfractionated RT in 1.2-1.5 Gy fractions twice daily with concomitant capecitabine. The median time since initial RT was 29 months (range, 13-174 months). Of 36 patients considered as potentially resectable, 20 underwent surgery for LRRC within 3 months after reRT. Operated patients had better 3-year overall survival (OS) (62%) compared to those who were not operated (16%; HR 0.32, p = .001). The median gross tumor volume (GTV) was 107 cm3, and 3-year OS was significantly better in patients with GTV <107 cm3 (44%) compared to patients with GTV ≥107 cm3 (21%; HR 0.52, p = .03).Conclusion: Three-year survival was significantly better for patients who underwent surgery after reRT or who had small tumor volume. Prospective clinical trials are recommended for further improvements in patient selection, outcomes, and toxicity assessment.
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Affiliation(s)
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Stein Gunnar Larsen
- Department of Gastrointestinal and Paediatric Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Svein Dueland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Eirik Malinen
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Marianne Grønlie Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway
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Cyr DP, Zih FS, Wells BJ, Swett-Cosentino J, Burkes RL, Brierley JD, Cummings B, Smith AJ, Swallow CJ. Long-term outcomes following salvage surgery for locally recurrent rectal cancer: A 15-year follow-up study. Eur J Surg Oncol 2020; 46:1131-1137. [PMID: 32224071 DOI: 10.1016/j.ejso.2020.02.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/20/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Locally recurrent rectal cancer (LRRC) is a complex problem requiring multidisciplinary consultation and specialized surgical care. Given the paucity of published longer-term survival data, skepticism persists regarding the benefit of major extirpative surgery. We investigated ultra-long-term (~15 years) outcomes following radical resection of LRRC and sought relevant clinicopathologic prognostic variables. METHODS A cohort of 52 consecutive patients who underwent resection of LRRC at our institution between 1997 and 2005 were followed with serial exams and imaging up to the point of death, or 30/06/2019. RESULTS Median follow-up time was 16.5 years (9.9-18.3) for patients who were alive at last follow-up; only one patient was lost to follow-up, at 9.9 years. For the entire cohort of 52 patients, disease-specific survival (DSS) at 5, 10, and 15 years following salvage surgery was 41%, 33%, and 31%, respectively. All patients who had distant metastatic disease at the time of LRRC resection (n = 6) subsequently died of cancer, at a median of 21 months (4-46). In those without distant metastases at time of salvage surgery (n = 46), DSS at 5, 10, and 15 years was 47%, 38%, and 35%, respectively, median 60 months. Negative resection margin (R0) was independently predictive of superior outcomes. In patients with M0 disease who had R0 resection (n = 37), DSS at 5, 10 and 15 years was 58%, 47%, and 44%, respectively, median 73 months. No patient developed re-recurrence after 5.5 years. CONCLUSIONS This study demonstrates exceptionally durable long-term cancer-free survival following salvage surgery for LRRC, indicating that cure is possible.
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Affiliation(s)
- David P Cyr
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Mount Sinai Hospital, Toronto, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Francis Sw Zih
- Department of Surgery, Surrey Memorial Hospital, Surrey, Canada; Division of General Surgery, Department of Surgery, University of British Columbia, Canada
| | - Bryan J Wells
- Division of General Surgery, Nanaimo Regional General Hospital, Nanaimo, Canada
| | | | - Ronald L Burkes
- Department of Medical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Canada
| | - James D Brierley
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Bernard Cummings
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Andrew J Smith
- Sunnybrook Health Sciences Centre and Odette Cancer Centre, Toronto, Canada
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Mount Sinai Hospital, Toronto, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.
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49
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Rombouts AJM, Hugen N, Elferink MAG, Poortmans PMP, Nagtegaal ID, de Wilt JHW. Increased risk for second primary rectal cancer after pelvic radiation therapy. Eur J Cancer 2019; 124:142-151. [PMID: 31765989 DOI: 10.1016/j.ejca.2019.10.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/02/2019] [Accepted: 10/15/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to analyse the association between pelvic radiation therapy (RT) and the development of rectal cancer as a second primary cancer. METHODS Data on patients treated for a primary pelvic cancer between 1989 and 2007 were retrieved from the population-based Netherlands Cancer Registry. Patients treated for more than one pelvic cancer were excluded. To estimate the cumulative incidence of rectal cancer, Fine and Gray's competing risk model was used with death as a competing event. Survival was calculated using multivariable Cox regression. RESULTS A total of 192,658 patients were included, of which 62,630 patients were treated with RT for their pelvic cancer. Primary tumours were located in the prostate (50.1%), bladder (19.2%), endometrium (13.9%), ovaries (10.0%), cervix (6.4%) and vagina (0.4%). At a median interval of 6 years (range 0-24), 1369 patients developed a rectal cancer. Overall, the risk for rectal cancer was increased in patients who underwent RT for the previous pelvic cancer (subhazard ratio [SHR]: 1.72, 95% confidence interval [CI]: 1.55-1.91). Analysis for each tumour location specifically showed an increased risk in patients who received RT for prostate (SHR: 1.89, 95% CI: 1.66-2.16) or endometrial cancer (SHR: 1.50, 95% CI: 1.13-2.00). A protective effect of RT was observed for patients with bladder cancer (SHR 0.67, 95% CI: 0.47-0.94). There was no survival difference between patients with rectal cancer with or without previous RT (hazard ratio: 0.94, 95% CI: 0.79-1.11). CONCLUSIONS Patients who received RT for a previous pelvic cancer were at increased risk for rectal cancer. The risk was modest and pronounced in patients receiving RT for prostate and endometrial cancer.
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Affiliation(s)
- Anouk J M Rombouts
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Niek Hugen
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Philip M P Poortmans
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Radiation Oncology, Institut Curie & Paris Sciences & Lettres - PSL University, Paris, France
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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50
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Chung SY, Koom WS, Keum KC, Chang JS, Shin SJ, Ahn JB, Min BS, Lee KY, Kim NK, Yoon HI. Treatment Outcomes of Re-irradiation in Locoregionally Recurrent Rectal Cancer and Clinical Significance of Proper Patient Selection. Front Oncol 2019; 9:529. [PMID: 31275858 PMCID: PMC6593136 DOI: 10.3389/fonc.2019.00529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/31/2019] [Indexed: 12/22/2022] Open
Abstract
Background and Purpose: Majority of patients with locoregionally recurrent rectal cancer will require re-irradation (reRT). This study aimed to analyze the treatment outcomes, particularly infield progression, and severe late toxicity rates after reRT for recurrent rectal cancer and further identify a subgroup of patients who may optimally benefit from reRT. Materials and Methods: Patients with rectal cancer who underwent reRT to the pelvis between January 2000 and December 2017 were included for analysis. Results: The records of 41 patients were retrospectively reviewed. The median follow-up period after reRT was 53.7 months (range 3.5–130.3 months). The 2-year infield progression-free rate (IPFR) was 49.4%. The 2-year overall survival (OS) and progression-free survival (PFS) rates were 55.3 and 28.5%, respectively. Severe late toxicity events occurred in 17 patients, and the median time from reRT to severe late toxicity event was 10.5 months (range 2.3–33.3 months). The 2-year severe late toxicity free-rate (SLTFR) was 55.5%, and the median SLTFR was 33.3 months. Patients who did not experience severe late toxicity events showed a significantly higher number of recurred tumors at the posterior or lateral location compared to axial or anterior location. The selected subgroup with recurrent tumor size <3.3 cm and treated with total reRT dose of >50 Gyab10 (n = 13) showed superior IPFR, OS, and PFS to the other patients. Conclusion: ReRT was a reasonable treatment option for patients with locoregionally recurrent rectal cancer. However, severe late toxicity rates were substantially high. Thus, patients indicated for ReRT with curative dose should be selected properly according to tumor size and location.
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Affiliation(s)
- Seung Yeun Chung
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Joon Shin
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Joong Bae Ahn
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Soh Min
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Kang Young Lee
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Nam Kyu Kim
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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