title: Palliative reirradiation for recurrent rectal cancer.
abstract: OBJECTIVE
  The purpose of this study was to analyze the efficacy and acute and late toxicity of reirradiation for recurrent rectal cancer.
  
  
  METHODS
  Fifty-two patients with recurrent rectal adenocarcinoma following previous pelvic RT underwent reirradiation. Median initial RT dose to the pelvis was 50.4 Gy. Median reirradiation dose was 30.6 Gy. Twenty-two patients received 1.2 Gy b.i.d., and 30 patients received 1.8-2.0 Gy daily. Total cumulative doses ranged from 66.6 to 104.9 Gy (median: 84.4 Gy). Forty-seven patients (90%) received concurrent 5-FU chemotherapy. Forty-four patients were followed until death, and the median follow-up time was 16 months.
  
  
  RESULTS
  The RTOG Grade 3 acute toxicity rate was 31%. The RTOG Grade 3 and 4 late toxicity rates were 23 and 10%, respectively. On multivariate analysis, the only factor associated with reduced late toxicity was hyperfractionated delivery of reirradiation. Bleeding, pain, and mass effect were palliated completely in 100, 65, and 24% of instances, respectively, and the majority of responding patients were palliated until death. The overall median survival time from retreatment was 12 months. The 2- and 3-year overall actuarial survival rates were 25 and 14%, respectively.
  
  
  CONCLUSIONS
  This unique institutional approach to recurrent rectal cancers resulted in excellent palliation of symptoms. Late complications appeared reduced by hyperfractionated treatment delivery.
authors.affiliation: Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: V
authors.initials: V
authors.lastname: Lingareddy
authors.forename: N R
authors.initials: NR
authors.lastname: Ahmad
authors.forename: M
authors.initials: M
authors.lastname: Mohiuddin
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery; D010166:Palliative Care; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis