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
Radiation Oncology
Published in: Radiation Oncology 1/2011

Open Access 01-12-2011 | Research

Palliative radiotherapy in patients with a symptomatic pelvic mass of metastatic colorectal cancer

Authors: Sun Hyun Bae, Won Park, Doo Ho Choi, Heerim Nam, Won Ki Kang, Young Suk Park, Joon Oh Park, Ho Kyung Chun, Woo Yong Lee, Seong Hyeon Yun, Hee Cheol Kim

Published in: Radiation Oncology | Issue 1/2011

Login to get access

Abstract

Background

To evaluate the palliative role of radiotherapy (RT) and define the effectiveness of chemotherapy combined with palliative RT (CCRT) in patients with a symptomatic pelvic mass of metastatic colorectal cancer.

Methods

From August 1995 to December 2007, 80 patients with a symptomatic pelvic mass of metastatic colorectal cancer were treated with palliative RT at Samsung Medical Center. Initial presenting symptoms were pain (68 cases), bleeding (18 cases), and obstruction (nine cases). The pelvic mass originated from rectal cancer in 58 patients (73%) and from colon cancer in 22 patients (27%). Initially 72 patients (90%) were treated with surgery, including 64 complete local excisions; 77% in colon cancer and 81% in rectal cancer. The total RT dose ranged 8-60 Gy (median: 36 Gy) with 1.8-8 Gy per fraction. When the α/β for the tumor was assumed to be 10 Gy for the biologically equivalent dose (BED), the median RT dose was 46.8 Gy10 (14.4-78). Twenty one patients (26%) were treated with CCRT. Symptom palliation was assessed one month after the completion of RT.

Results

Symptom palliation was achieved in 80% of the cases. During the median follow-up period of five months (1-44 months), 45% of the cases experienced reappearance of symptoms; the median symptom control duration was five months. Median survival after RT was six months. On univariate analysis, the only significant prognostic factor for symptom control duration was BED ≥40 Gy10 (p < 0.05), and CCRT was a marginally significant factor (p = 0.0644). On multivariate analysis, BED and CCRT were significant prognostic factors for symptom control duration (p < 0.05).

Conclusions

RT was an effective palliation method in patients with a symptomatic pelvic mass of metastatic colorectal cancer. For improvement of symptom control rate and duration, a BED ≥ 40 Gy10 is recommended when possible. Considering the low morbidity and improved symptom palliation, CCRT might be considered in patients with good performance status.
Appendix
Available only for authorised users
Literature
1.
Rao AR, Kagan AR, Chan PM, Gilbert HA, Nussbaum H, Hintz BL: Patterns of recurrence following curative resection alone for adenocarcinoma of the rectum and sigmoid colon. Cancer 1981,48(6):1492-5. 10.1002/1097-0142(19810915)48:6<1492::AID-CNCR2820480636>3.0.CO;2-KCrossRefPubMed
2.
Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP: Local recurrence following 'curative' surgery for large bowel cancer: II. The rectum and rectosigmoid. Br J Surg 1984, 71: 17-20. 10.1002/bjs.1800710105CrossRefPubMed
3.
Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE: Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984, 53: 1354-1362. 10.1002/1097-0142(19840315)53:6<1354::AID-CNCR2820530623>3.0.CO;2-JCrossRefPubMed
4.
Douglass HO Jr, Moertel CG, Mayer RJ, Thomas PR, Lindblad AS, Mittleman A, Stablein DM, Bruckner HW: Survival after postoperative combination treatment of rectal cancer. N Engl J Med 1986, 315: 1294-1295.CrossRefPubMed
5.
Fisher B, Wolmark N, Rockette H, Redmond C, Deutsch M, Wickerham DL, Fisher ER, Caplan R, Jones J, Lerner H, Gordon P, Feldman M, Cruz A, Legault-Poisson S, Wexler M, Lawrence W, Robidoux A, Other NSABP investigators: Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst 1988,80(1):21-9. 10.1093/jnci/80.1.21CrossRefPubMed
6.
Gérard A, Buyse M, Nordlinger B, Loygue J, Pène F, Kempf P, Bosset JF, Gignoux M, Arnaud JP, Desaive C, Duez N: Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surg 1988,208(5):606-14. 10.1097/00000658-198811000-00011PubMedCentralCrossRefPubMed
7.
Krook JE, Moertel CG, Gunderson LL, Wieand HS, Collins RT, Beart RW, Kubista TP, Poon MA, Meyers WC, Mailliard JA, Twito DI, Morton RF, Veeder MH, Witzig TE, Cha S, Vidyarthi SC: Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991,324(11):709-15. 10.1056/NEJM199103143241101CrossRefPubMed
8.
Lybeert ML, Martijn H, de Neve W, Crommelin MA, Ribot JG: Radiotherapy for locoregional relapses of rectal carcinoma after initial radical surgery: definite but limited influence on relapse-free survival and survival. Int J RadiatOncolBiolPhys 1992,24(2):241-6.
9.
Wong CS, Cummings BJ, Brierley JD, Catton CN, McLean M, Catton P, Hao Y: Treatment of locally recurrent rectal carcinoma--results and prognostic factors. Int J RadiatOncolBiolPhys 1998,40(2):427-35.
10.
Kleespies A, Füessl KE, Seeliger H, Eichhorn ME, Müller MH, Rentsch M, Thasler WE, Angele MK, Kreis ME, Jauch KW: Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer. Int J Colorectal Dis 2009,24(9):1097-109. Epub 2009 Jun 3 10.1007/s00384-009-0734-yCrossRefPubMed
11.
Willett CG, Gunderson LL: Palliative treatment of rectal cancer: is radiotherapy alone a good option? J Gastrointest Surg 2004,8(3):277-9. 10.1016/j.gassur.2003.11.015CrossRefPubMed
12.
Gunderson LL, Martenson JA: Irradiation of adenocarcinomas of the gastrointestinal tract. Front RadiatTherOncol 1988, 22: 127-148.
13.
Williams IG: Radiotherapy of carcinoma of the rectum. In Dukes C, ed. Cancer of the Rectum. E&S Livingston, Edinburgh 1960, 210-219.
14.
Whiteley HW Jr, Stearns MW Jr, Leaming RH, Deddish MR: Radiation therapy in the palliative management of patients with recurrent cancer of the rectum and colon. SurgClin North Am 1969, 49: 381-387.
15.
Moertel CG, Childs DS Jr, Reitemeier RJ, Colby MY Jr, Holbrook MA: Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet 1969,2(7626):865-867.CrossRefPubMed
16.
Urdaneta-Lafee N, Kligerman MM, Knowlton AH: Evaluation of palliative irradiation in rectal carcinoma. Radiology 1972, 104: 673-677.CrossRefPubMed
17.
Wang CC, Schulz MD: The role of radiation therapy in the management of carcinoma of the sigmoid, rectosigmoid, and rectum. Radiol 1962, 79: 1-5.CrossRef
18.
Gunderson LL, Cohen AM, Welch CW: Residual, inoperable, or recurrent colorectal cancer: surgical radiotherapy interaction. Am J Surg 1980, 139: 518-525. 10.1016/0002-9610(80)90330-XCrossRefPubMed
19.
O'Connell MJ, Childs DS, Moertel CG, Holbrook MA, Schutt AJ, Rubin J, Ritts RE Jr: A prospective controlled evaluation of combined pelvic radiotherapy and methanol extraction residue of BCG (MER) for locally unresectable or recurrent rectal carcinoma. Int J RadiatOncolBiolPhys 1982,8(7):1115-1119.
20.
Rominger CJ, Gunderson LL, Gelber RD, Conner N: Radiation therapy alone or in combination with chemotherapy in the treatment of residual or inoperable carcinoma of the rectum and rectosigmoid or pelvic recurrence following colorectal surgery. Radiation Therapy Oncology Group study (76-16). Am J ClinOncol 1985, 8: 118-127.CrossRef
21.
Lingareddy V, Ahmad NR, Mohiuddin M: Palliative reirradiation for recurrent rectal cancer. Int J RadiatOncol Biol Phys 1997,38(4):785-90. 10.1016/S0360-3016(97)00058-8CrossRef
22.
Crane CH, Janjan NA, Abbruzzese JL, Curley S, Vauthey J, Sawaf HB, Dubrow R, Allen P, Ellis LM, Hoff P, Wolff RA, Lenzi R, Brown TD, Lynch P, Cleary K, Rich TA, Skibber J: Effective pelvic symptom control using initial chemoradiation without colostomy in metastatic rectal cancer. Int J Radiat Oncol Biol Phys 2001,49(1):107-16. 10.1016/S0360-3016(00)00777-XCrossRefPubMed
23.
Mohiuddin M, Marks G, Marks J: Long-term results of reirradiation for patients with recurrent rectal carcinoma. Cancer 2002,95(5):1144-50. 10.1002/cncr.10799CrossRefPubMed
24.
Poultsides GA, Servais EL, Saltz LB, Patil S, Kemeny NE, Guillem JG, Weiser M, Temple LK, Wong WD, Paty PB: Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol 2009,27(20):3379-84. Epub 2009 Jun 1 10.1200/JCO.2008.20.9817PubMedCentralCrossRefPubMed
25.
Cameron S, Hünerbein D, Mansuroglu T, Armbrust T, Scharf JG, Schwörer H, Füzesi L, Ramadori G: Response of the primary tumor in symptomatic and asymptomatic stage IV colorectal cancer to combined interventional endoscopy and palliative chemotherapy. BMC Cancer 2009, 9: 218. 10.1186/1471-2407-9-218PubMedCentralCrossRefPubMed
26.
Kim MM, Rana V, Janjan NA, Das P, Phan AT, Delclos ME, Mansfield PF, Ajani JA, Crane CH, Krishnan S: Clinical benefit of palliative radiation therapy in advanced gastric cancer. ActaOncol 2008,47(3):421-7.
27.
Coia LR, Soffen EM, Schultheiss TE, Martin EE, Hanks GE: Swallowing function in patients with esophageal cancer treated with concurrent radiation and chemotherapy. Cancer 1993,71(2):281-6. 10.1002/1097-0142(19930115)71:2<281::AID-CNCR2820710202>3.0.CO;2-0CrossRefPubMed
28.
Burmeister BH, Denham JW, O'Brien M, Jamieson GG, Gill PG, Devitt P, Yeoh E, Hamilton CS, Ackland SP, Lamb DS, Spry NA, Joseph DJ, Atkinson C, Walker QJ: Combined modality therapy for esophageal carcinoma: preliminary results from a large Australasian multicenter study. Int J RadiatOncolBiolPhys 1995,32(4):997-1006.
29.
Hayter CR, Huff-Winters C, Paszat L, Youssef YM, Shelley WE, Schulze K: A prospective trial of short-course radiotherapy plus chemotherapy for palliation of dysphagia from advanced esophageal cancer. RadiotherOncol 2000,56(3):329-33.
30.
Harvey JA, Bessell JR, Beller E, Thomas J, Gotley DC, Burmeister BH, Walpole ET, Thomson DB, Martin I, Doyle L, Burmeister E, Smithers BM: Chemoradiation therapy is effective for the palliative treatment of malignant dysphagia. Dis Esophagus 2004,17(3):260-5. 10.1111/j.1442-2050.2004.00420.xCrossRefPubMed
31.
Kaplan EL, Meier P: Non-parametric estimation from incomplete observations. J Am Statisticians Assoc 1958, 53: 457-481. 10.2307/2281868CrossRef
32.
Harris E, Albert A: Survivorship analysis for clinical studies. New York, NY, Dekker; 1991.
33.
Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M: Tolerance of normal tissue to therapeutic irradiation. Int J RadiatOncolBiolPhys 1991, 21: 109-122.
34.
Nieder C, Milas L, Ang KK: Tissue tolerance to reirradiation. Semin Radiat Oncol 2000,10(3):200-9. 10.1053/srao.2000.6593CrossRefPubMed
35.
Wong CS, Cummings BJ, Keane TJ, Dobrowsky W, O'Sullivan B, Catton CN: Combined radiation therapy, mitomycin C, and 5-fluorouracil for locally recurrent rectal carcinoma: results of a pilot study. Int J Radiat Oncol Biol Phys 1991,21(5):1291-6. 10.1016/0360-3016(91)90288-FCrossRefPubMed
36.
Tey J, Back MF, Shakespeare TP, Mukherjee RK, Lu JJ, Lee KM, Wong LC, Leong CN, Zhu M: The role of palliative radiation therapy insymptomatic locally advanced gastric cancer. Int J RadiatOncolBiolPhys 2007,67(2):385-8. Epub 2006 Nov 21
Metadata
Title
Palliative radiotherapy in patients with a symptomatic pelvic mass of metastatic colorectal cancer
Authors
Sun Hyun Bae
Won Park
Doo Ho Choi
Heerim Nam
Won Ki Kang
Young Suk Park
Joon Oh Park
Ho Kyung Chun
Woo Yong Lee
Seong Hyeon Yun
Hee Cheol Kim
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2011
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-6-52

Other articles of this Issue 1/2011

Radiation Oncology 1/2011 Go to the issue

Research

Toxicity after radiochemotherapy for glioblastoma using temozolomide - a retrospective evaluation

Review

Radiotherapy and "new" drugs-new side effects?

Research

Bilateral kidney preservation by volumetric-modulated arc therapy (RapidArc) compared to conventional radiation therapy (3D-CRT) in pancreatic and bile duct malignancies

Research

The in vivo study on the radiobiologic effect of prolonged delivery time to tumor control in C57BL mice implanted with Lewis lung cancer

Case report

Spinal cord stimulators and radiotherapy: First case report and practice guidelines

Research

An ultrasonographic evaluation of skin thickness in breast cancer patients after postmastectomy radiation therapy