title: Stereotactic body radiotherapy for the treatment of presacral recurrences from rectal cancers.
abstract: OBJECTIVE
  Management of recurrent presacral rectal cancer is often not amenable to curative surgery. The goal of this study is to evaluate the safety and efficacy of cyberknife stereotactic body radiotherapy (SBRT) in the management of presacral recurrences.
  
  
  METHODS
  Between April 2003 and October 2008, 14 patients with presacral tumors from rectal adenocarcinoma were SBRT treated. Eleven patients were treated with 36 Gy in 3 fractions and 3 patients were treated with single fraction of 12, 16 or 18 Gy. Tumor response was assessed using response evaluation and criteria in solid tumor (RECIST) criteria. Toxicities were assessed with common terminology criteria adverse events v 3.0. Pain control was assessed.
  
  
  RESULTS
  One patient (6.7%) received SBRT as boost therapy. All patients had prior radiotherapy [median 50.4 Gy (20 - 81 Gy)]. Median tumor volume was 52.5 cc (19 - 110 cc). At initial follow-up of a median 4.9 months (1 - 16.3 months), treatment responses were complete response (n=3) and stable disease (n=8). With a median follow-up of 16.5 months (6 - 69 months), the one- and two-year LC rates were 90.9 and 68.2%, respectively, and the one- and two-year OS rates were 90 and 78.8%, respectively. No factors were significantly predictive of LC and OS. There were no grade 3 or 4 toxicities. Fifty percent (n=7) of our patients experienced pain with recurrence before treatment and 4 (57.1%) of them reported no pain after completion of their SBRT.
  
  
  CONCLUSIONS
  Stereotactic body radiotherapy for presacral recurrence of rectal adenocarcinoma is an efficacious and well-tolerated treatment modality which allows for palliation of pain.
authors.affiliation: Department of Radiation Oncology, Head and Neck Surgery, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232, USA.
authors.forename: Sarahgene G
authors.initials: SG
authors.lastname: Defoe
authors.forename: Mark E
authors.initials: ME
authors.lastname: Bernard
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Rwigema
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.forename: Cihat
authors.initials: C
authors.lastname: Ozhasoglu
authors.forename: Steven
authors.initials: S
authors.lastname: Burton
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate