Hyperfractionated accelerated radiotherapy for rectal cancer in patients with prior pelvic irradiation.
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.
Das
Prajnan
P
Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. PrajDas@mdanderson.org
Delclos
Marc E
ME
Skibber
John M
JM
Rodriguez-Bigas
Miguel A
MA
Feig
Barry W
BW
Chang
George J
GJ
Eng
Cathy
C
Bedi
Manpreet
M
Krishnan
Sunil
S
Crane
Christopher H
CH
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
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D011725:Pyridines; C431073:oxiplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil