title: Robotic image-guided reirradiation of lateral pelvic recurrences: preliminary results.
abstract: BACKGROUND
  The first-line treatment of a pelvic recurrence in a previously irradiated area is surgery. Unfortunately, few patients are deemed operable, often due to the location of the recurrence, usually too close to the iliac vessels, or the associated surgical morbidity. The objective of this study is to test the viability of robotic image-guided radiotherapy as an alternative treatment in inoperable cases.
  
  
  METHODS
  Sixteen patients previously treated with radiotherapy were reirradiated with CyberKnife® for lateral pelvic lesions. Recurrences of primary rectal cancer (4 patients), anal canal (6), uterine cervix cancer (4), endometrial cancer (1), and bladder carcinoma (1) were treated. The median dose of the previous treatment was 45 Gy (EqD2 range: 20 to 96 Gy). A total dose of 36 Gy in six fractions was delivered with the CyberKnife over three weeks. The responses were evaluated according to RECIST criteria.
  
  
  RESULTS
  Median follow-up was 10.6 months (1.9 to 20.5 months). The actuarial local control rate was 51.4% at one year. Median disease-free survival was 8.3 months after CyberKnife treatment. The actuarial one-year survival rate was 46%. Acute tolerance was limited to digestive grade 1 and 2 toxicities.
  
  
  CONCLUSIONS
  Robotic stereotactic radiotherapy can offer a short and well-tolerated treatment for lateral pelvic recurrences in previously irradiated areas in patients otherwise not treatable. Efficacy and toxicity need to be evaluated over the long term, but initial results are encouraging.
authors.affiliation: Département Universitaire de Radiothérapie, CyberKnife Nord-Ouest, Centre Oscar Lambret, CLCC, Université Lille II, Lille, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Dewas
authors.forename: Jean Emmanuel
authors.initials: JE
authors.lastname: Bibault
authors.forename: Xavier
authors.initials: X
authors.lastname: Mirabel
authors.forename: Philippe
authors.initials: P
authors.lastname: Nickers
authors.forename: Bernard
authors.initials: B
authors.lastname: Castelain
authors.forename: Thomas
authors.initials: T
authors.lastname: Lacornerie
authors.forename: Hajer
authors.initials: H
authors.lastname: Jarraya
authors.forename: Eric
authors.initials: E
authors.lastname: Lartigau
mesh_terms: D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000532:radiotherapy; D003952:Diagnostic Imaging / Q000379:methods; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000473:pathology* / Q000628:therapy; D016634:Radiosurgery / Q000379:methods; D061089:Radiotherapy, Image-Guided / Q000379:methods; D012004:Rectal Neoplasms / Q000532:radiotherapy; D012008:Recurrence; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy