title: Reirradiation of locally recurrent rectal cancer: a systematic review.
abstract: BACKGROUND
  Many patients with rectal cancer receive radiotherapy as a component of primary multimodality treatment. Although local recurrence is infrequent, reirradiation may be needed to improve resectability and outcomes. This systematic review investigated the effects of reirradiation in terms of feasibility, toxicity, and long-term outcomes.
  
  
  METHODS
  A Medline, Embase and Cochrane search resulted in 353 titles/abstracts. Ten publications describing seven prospective or retrospective studies were included, presenting results of 375 patients reirradiated for rectal cancer.
  
  
  RESULTS
  Median initial radiation dose was 50.4Gy, median 8-30months before reirradiation. Reirradiation was mostly administered using hyperfractionated (1.2-1.5Gy twice-daily) or 1.8Gy once-daily chemoradiotherapy. Median total dose was 30-40Gy to the gross tumour volume with 2-4cm margins. Median survival was 39-60months in resected patients and 12-16months in palliative patients. Good symptomatic relief was reported in 82-100%. Acute toxicity with diarrhoea was reported in 9-20%, late toxicity was insufficiently reported.
  
  
  CONCLUSIONS
  Reirradiation of rectal cancer to limited volumes is feasible. When curative resection is possible, the goal is radical resection and long-term survival, and hyperfractionated chemoradiotherapy should be preferred to limit late toxicity. Reirradiation yielded good symptomatic relief in palliative treatment.
authors.affiliation: Department of Oncology, Oslo University Hospital, Norway; K.G.Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norway. Electronic address: Marianne.gronlie.guren@ous-hf.no.
authors.forename: Marianne Grønlie
authors.initials: MG
authors.lastname: Guren
authors.affiliation: Department of Oncology, Oslo University Hospital, Norway.
authors.forename: Christine
authors.initials: C
authors.lastname: Undseth
authors.affiliation: Department of Medical Physics, Oslo University Hospital, Norway.
authors.forename: Bernt Louni
authors.initials: BL
authors.lastname: Rekstad
authors.affiliation: Department of Oncology, Oslo University Hospital, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: Brændengen
authors.affiliation: Department of Oncology, Oslo University Hospital, Norway.
authors.forename: Svein
authors.initials: S
authors.lastname: Dueland
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Karen-Lise Garm
authors.initials: KL
authors.lastname: Spindler
authors.affiliation: Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Glynne-Jones
authors.affiliation: Department of Oncology, Oslo University Hospital, Norway; K.G.Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Norway; University of Oslo, Norway.
authors.forename: Kjell Magne
authors.initials: KM
authors.lastname: Tveit
mesh_terms: D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D012004:Rectal Neoplasms / Q000532:radiotherapy*
keywords: Radiotherapy; Rectal cancer; Recurrence; Retreatment; Systematic review