Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2016

01-10-2016 | Radiation Oncology

The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer

Authors: Matthew Susko, MS, Jason Lee, MD, PhD, Joseph Salama, MD, Samantha Thomas, MS, Hope Uronis, MD, David Hsu, MD, PhD, John Migaly, MD, Christopher Willett, MD, Brian Czito, MD, Manisha Palta, MD

Published in: Annals of Surgical Oncology | Issue 11/2016

Login to get access

Abstract

Background

The optimal approach to patients with locally recurrent, non-metastatic rectal cancer is unclear. This study evaluates the outcomes and toxicity associated with pelvic re-irradiation.

Methods

Patients undergoing re-irradiation for locally recurrent, non-metastatic, rectal cancer between 2000 and 2014 were identified. Acute and late toxicities were assessed using common terminology criteria for adverse events version 4.0. Disease-related endpoints included palliation of local symptoms, surgical outcomes, and local progression-free survival (PFS), distant PFS and overall survival (OS) using the Kaplan–Meier method.

Results

Thirty-three patients met the criteria for inclusion in this study. Two (6 %) experienced early grade 3+ toxicity and seven (21 %) experienced late grade 3+ toxicity. Twenty-three patients presented with symptomatic local recurrence and 18 (78 %) reported symptomatic relief. Median local PFS was 8.7 (95 % CI 3.8–15.2) months, with a 2-year rate of 15.7 % (4.1–34.2), and median time to distant progression was 4.4 (2.2–33.3) months, with a 2-year distant PFS rate of 38.9 % (20.1–57.3). Median OS time for patients was 23.1 (11.1–33.0) months. Of the 14 patients who underwent surgery, median survival was 32.3 (13.8–48.0) months compared with 13.3 (2.2–33.0) months in patients not undergoing surgery (p = 0.10). A margin-negative (R0) resection was achieved in 10 (71 %) of the surgeries. Radiation treatment modality (intensity-modulated radiation therapy, three-dimensional conformal radiotherapy, intraoperative radiation therapy) did not influence local or distant PFS or OS.

Conclusion

Re-irradiation is a beneficial treatment modality for the management of locally recurrent, non-metastatic rectal cancer. It is associated with symptom improvement, low rates of toxicity, and similar benefits among radiation modalities.
Literature
1.
2.
Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.CrossRefPubMed
3.
Thomas PR, Lindblad AS. Adjuvant postoperative radiotherapy and chemotherapy in rectal carcinoma: a review of the Gastrointestinal Tumor Study Group experience. Radiother Oncol. 1988;13(4):245–52.CrossRefPubMed
4.
SRC Trial Group. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med. 1997;336(14):980–7.CrossRef
5.
Das P, Skibber JM, Rodriguez-Bigas MA, et al. Clinical and pathologic predictors of locoregional recurrence, distant metastasis, and overall survival in patients treated with chemoradiation and mesorectal excision for rectal cancer. Am J Clin Oncol. 2006;29(3):219–24.CrossRef
6.
Yu TK, Bhosale PR, Crane CH, et al. Patterns of locoregional recurrence after surgery and radiotherapy or chemoradiation for rectal cancer. Int J Radiat Oncol Biol Phys. 2008;71(4):1175–80.CrossRefPubMed
7.
Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer. 1984;53(6):1354–62.CrossRefPubMed
8.
Lingareddy V, Ahmad NR, Mohiuddin M. Palliative reirradiation for recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 1997;38(4):785–90.CrossRefPubMed
9.
10.
Valentini V, Morganti AG, Gambacorta MA, et al. Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: A multicentric phase II study. Int J Radiat Oncol Biol Phys. 2006;64(4):1129–39.CrossRefPubMed
11.
Camilleri-Brennan J, Steele RJ. The impact of recurrent rectal cancer on quality of life. Eur J Surg Oncol. 2001;27(4):349–53.CrossRefPubMed
12.
Guiney MJ, Smith JG, Worotniuk V, Ngan S, Blakey D. Radiotherapy treatment for isolated loco-regional recurrence of rectosigmoid cancer following definitive surgery: Peter MacCallum Cancer Institute experience, 1981–1990. Int J Radiat Oncol Biol Phys. 1997;38(5):1019–25.CrossRefPubMed
13.
Das P, Delclos ME, Skibber JM, et al. Hyperfractionated accelerated radiotherapy for rectal cancer in patients with prior pelvic irradiation. Int J Radiat Oncol Biol Phys. 2010;77(1):60–5.CrossRefPubMed
14.
Suzuki K, Gunderson LL, Devine RM, et al. Intraoperative irradiation after palliative surgery for locally recurrent rectal cancer. Cancer. 1995;75(4):939–52.CrossRefPubMed
15.
Mohiuddin M, Marks G, Marks J. Long-term results of reirradiation for patients with recurrent rectal carcinoma. Cancer. 2002;95(5):1144–50.CrossRefPubMed
16.
Camma C, Giunta M, Fiorica F, Pagliaro L, Craxi A, Cottone M. Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA. 2000;284(8):1008–15.CrossRefPubMed
17.
Gunderson LL, Sargent DJ, Tepper JE, et al. Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: a pooled analysis. J Clin Oncol. 2004;22(10):1785–96.CrossRefPubMed
18.
Koom WS, Choi Y, Shim SJ, et al. Reirradiation to the pelvis for recurrent rectal cancer. J Surg Oncol. 2012;105(7): 637–42.CrossRefPubMed
19.
Lindel K, Willett CG, Shellito PC, et al. Intraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer. Radiother Oncol. 2001;58(1):83–7.CrossRefPubMed
20.
Cai G, Zhu J, Hu W, Zhang Z. Accelerated hyperfractionated intensity-modulated radiotherapy for recurrent/unresectable rectal cancer in patients with previous pelvic irradiation: results of a phase II study. Radiat Oncol. 2014;9:278.CrossRefPubMedPubMedCentral
Metadata
Title
The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer
Authors
Matthew Susko, MS
Jason Lee, MD, PhD
Joseph Salama, MD
Samantha Thomas, MS
Hope Uronis, MD
David Hsu, MD, PhD
John Migaly, MD
Christopher Willett, MD
Brian Czito, MD
Manisha Palta, MD
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 11/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5250-z

Other articles of this Issue 11/2016

Annals of Surgical Oncology 11/2016 Go to the issue

Hepatobiliary Tumors

Parenchymal-Sparing Hepatectomy Does Not Increase Intrahepatic Recurrence in Patients with Advanced Colorectal Liver Metastases

Gastrointestinal Oncology

Hepatic Resection for Metastatic Neuroendocrine Cancer in Patients with Bone Metastases

Gastrointestinal Oncology

Low Preoperative Prognostic Nutritional Index Predicts Poor Survival Post-gastrectomy in Elderly Patients with Gastric Cancer

Breast Oncology

Margins in DCIS: Does Residual Disease Provide an Answer?

Melanomas

LYMPHA Technique to Prevent Secondary Lower Limb Lymphedema

Reconstructive Oncology

Feasibility and Outcomes of the Third or More Episodes of Sequential Microvascular Reconstruction for Recurrent or Second Primary Oral Cancer