Radiochemotherapy in combination with regional hyperthermia in preirradiated patients with recurrent rectal cancer.
OBJECTIVE
Encouraging results of phase II studies combining chemotherapy with radiotherapy have been published. In this study, the results of a multimodal salvage therapy including radiochemotherapy (RCT) and regional hyperthermia (RHT) in preirradiated patients with recurrent rectal cancer are reported.


METHODS
All patients enrolled had received previous pelvic irradiation (median dose 50.4 Gy). The median time interval between prior radiotherapy and the onset of local recurrence was 34 months. The combined treatment consisted of reirradiation with a median dose of 39.6 Gy (30.0-45.0 Gy), delivered in fractions of 1.8 Gy/day. 5-fluorouracil was given as continuous infusion 350 mg/m(2)/day five times weekly, and RHT (BSD-2000 system) was applied twice a week within 1 h after radiotherapy. The primary endpoint was local progression-free survival (LPFS); secondary endpoints were overall survival, symptom control, and toxicity.


RESULTS
24 patients (median age 59 years) with a previously irradiated locally recurrent adenocarcinoma of the rectum were enrolled. The median LPFS was 15 months (95% confidence interval 12-18 months] with a median follow-up of 27 months (16-37 months). The overall 1-year and 3-year survival rates were 87% and 30%, respectively. Pain was the main symptom in 17 patients. Release of pain was achieved in 12/17 patients (70%). No grade 3 or 4 hematologic or skin toxicity occurred. Grade 3 gastrointestinal acute toxicity was observed in 12.5% of the patients. Paratumoral thermometry revealed a homogeneous distribution of temperatures.


CONCLUSIONS
RCT combined with RHT is an efficient salvage therapy showing high efficacy with acceptable toxicity and can be recommended as treatment option for this unfavorable group of preirradiated patients with local recurrence of rectal cancer.
Milani
Valeria
V
Department of Internal Medicine III, University Hospital Grosshadern, Ludwig Maximilians University, Munich, Germany. valeria.milani@med.uni-muenchen.de
Pazos
Montserrat
M
Issels
Rolf Dieter
RD
Buecklein
Veit
V
Rahman
Sultan
S
Tschoep
Katharina
K
Schaffer
Pamela
P
Wilkowski
Ralf
R
Duehmke
Eckhart
E
Schaffer
Moshe
M
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy / Q000628:therapy*; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D016001:Confidence Intervals; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy / Q000628:therapy*; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D018579:Patient Selection; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy / Q000628:therapy*; D012007:Rectum / Q000473:pathology; D016879:Salvage Therapy; D016019:Survival Analysis; D013997:Time Factors
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil