title: Reirradiation to the abdomen for gastrointestinal malignancies.
abstract: BACKGROUND
  Reirradiation to the abdomen could potentially play a role in palliation of symptoms or local control in patients with gastrointestinal malignancies. Our goal was to retrospectively determine rates of toxicity, freedom from local progression and overall survival in gastrointestinal cancer patients treated with reirradiation to the abdomen.
  
  
  METHODS
  Between November 2002 and September 2008, 13 patients with a prior history of abdominal radiotherapy (median dose 45 Gy) were treated with reirradiation for recurrent or metastatic gastrointestinal malignancies. The median interval between the two courses of radiotherapy was 26 months. Patients were treated with a hyperfractionated accelerated regimen, using 1.5 Gy fractions twice daily, with a median dose of 30 Gy (range 24-48 Gy). Concurrent chemotherapy was administered to 8 (62%) patients.
  
  
  RESULTS
  The 1-year rate of freedom from local progression was 50%, and the median duration of freedom from local progression was 14 months. The 1-year rate of overall survival was 62%, and the median duration of overall survival was 14 months. One patient developed grade 3 acute toxicity (abdominal pain and gastrointestinal bleeding), requiring hospitalization during radiotherapy; subsequently, that patient experienced a grade 4 late toxicity (gastrointestinal bleeding). No other patients developed grade 3-4 acute or late toxicity or required hospitalization during radiotherapy.
  
  
  CONCLUSIONS
  Hyperfractionated accelerated reirradiation to the abdomen was well-tolerated with low rates of acute and late toxicity. Reirradiation could play a role in providing a limited duration of local control in gastrointestinal cancer patients with a history of prior abdominal radiotherapy.
authors.affiliation: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. prajdas@mdanderson.org.
authors.forename: Waqar
authors.initials: W
authors.lastname: Haque
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
authors.forename: Marc E
authors.initials: ME
authors.lastname: Delclos
authors.forename: Milind
authors.initials: M
authors.lastname: Javle
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Garrett
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*