title: Hyperfractionated accelerated radiotherapy for rectal cancer in patients with prior pelvic irradiation.
abstract: OBJECTIVE
  To retrospectively determine rates of toxicity, freedom from local progression, and survival in rectal cancer patients treated with reirradiation.
  
  
  METHODS
  Between February 2001 and February 2005, 50 patients with a history of pelvic radiotherapy were treated with hyperfractionated accelerated radiotherapy for primary (n = 2 patients) or recurrent (n = 48 patients) rectal adenocarcinoma. Patients were treated with 150-cGy fractions twice daily, with a total dose of 39 Gy (n = 47 patients) if the retreatment interval was >or=1 year or 30 Gy (n = 3) if the retreatment interval was <1 year. Concurrent chemotherapy was administered to 48 (96%) patients. Eighteen (36%) patients underwent surgical resection following radiotherapy.
  
  
  RESULTS
  Two patients had grade 3 acute toxicity and 13 patients had grade 3 to 4 late toxicity. The 3-year rate of grade 3 to 4 late toxicity was 35%. The 3-year rate of freedom from local progression was 33%. The 3-year freedom from local progression rate was 47% in patients undergoing surgery and 21% in those not undergoing surgery (p = 0.057). The 3-year overall survival rate was 39%. The 3-year overall survival rate was 66% in patients undergoing surgery and 27% in those not undergoing surgery (p = 0.003). The 3-year overall survival rate was 53% in patients with a retreatment interval of >2 years and 21% in those with a retreatment interval of <or=2 years (p = 0.001).
  
  
  CONCLUSIONS
  Hyperfractionated, accelerated reirradiation was well tolerated, with low rates of acute toxicity and moderate rates of late toxicity. Reirradiation may help improve pelvic control in rectal cancer patients with a history of pelvic radiotherapy.
authors.affiliation: Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. PrajDas@mdanderson.org
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.forename: Marc E
authors.initials: ME
authors.lastname: Delclos
authors.forename: John M
authors.initials: JM
authors.lastname: Skibber
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rodriguez-Bigas
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: George J
authors.initials: GJ
authors.lastname: Chang
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
authors.forename: Manpreet
authors.initials: M
authors.lastname: Bedi
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000069287:Capecitabine; D003131:Combined Modality Therapy / Q000379:methods; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010388:Pelvis; D011725:Pyridines / Q000008:administration & dosage; D011832:Radiation Injuries / Q000453:epidemiology*; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D019233:Retreatment; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D011725:Pyridines; C431073:oxiplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil