title: The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer.
abstract: The optimal approach to patients with locally recurrent, non-metastatic rectal cancer is unclear. This study evaluates the outcomes and toxicity associated with pelvic re-irradiation.
  
  
  
  Patients undergoing re-irradiation for locally recurrent, non-metastatic, rectal cancer between 2000 and 2014 were identified. Acute and late toxicities were assessed using common terminology criteria for adverse events version 4.0. Disease-related endpoints included palliation of local symptoms, surgical outcomes, and local progression-free survival (PFS), distant PFS and overall survival (OS) using the Kaplan-Meier method.
  
  
  
  Thirty-three patients met the criteria for inclusion in this study. Two (6 %) experienced early grade 3+ toxicity and seven (21 %) experienced late grade 3+ toxicity. Twenty-three patients presented with symptomatic local recurrence and 18 (78 %) reported symptomatic relief. Median local PFS was 8.7 (95 % CI 3.8-15.2) months, with a 2-year rate of 15.7 % (4.1-34.2), and median time to distant progression was 4.4 (2.2-33.3) months, with a 2-year distant PFS rate of 38.9 % (20.1-57.3). Median OS time for patients was 23.1 (11.1-33.0) months. Of the 14 patients who underwent surgery, median survival was 32.3 (13.8-48.0) months compared with 13.3 (2.2-33.0) months in patients not undergoing surgery (p = 0.10). A margin-negative (R0) resection was achieved in 10 (71 %) of the surgeries. Radiation treatment modality (intensity-modulated radiation therapy, three-dimensional conformal radiotherapy, intraoperative radiation therapy) did not influence local or distant PFS or OS.
  
  
  
  Re-irradiation is a beneficial treatment modality for the management of locally recurrent, non-metastatic rectal cancer. It is associated with symptom improvement, low rates of toxicity, and similar benefits among radiation modalities.
authors.affiliation: Department of Radiation Oncology, Duke Cancer Center, Durham, NC, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Susko
authors.affiliation: Department of Radiation Oncology, Duke Cancer Center, Durham, NC, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Duke Cancer Center, Durham, NC, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Salama
authors.affiliation: Department of Radiation Oncology, Duke Cancer Center, Durham, NC, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Department of Radiation Oncology, Duke Cancer Center, Durham, NC, USA.
authors.forename: Hope
authors.initials: H
authors.lastname: Uronis
authors.affiliation: Department of Radiation Oncology, Duke Cancer Center, Durham, NC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hsu
authors.affiliation: Department of Radiation Oncology, Duke Cancer Center, Durham, NC, USA.
authors.forename: John
authors.initials: J
authors.lastname: Migaly
authors.affiliation: Department of Radiation Oncology, Duke Cancer Center, Durham, NC, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Willett
authors.affiliation: Department of Radiation Oncology, Duke Cancer Center, Durham, NC, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Czito
authors.affiliation: Department of Radiation Oncology, Duke Cancer Center, Durham, NC, USA. manisha.palta@duke.edu.
authors.forename: Manisha
authors.initials: M
authors.lastname: Palta
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D006801:Humans; D053208:Kaplan-Meier Estimate; D000072662:Margins of Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010166:Palliative Care; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D019233:Retreatment; D015996:Survival Rate; D063189:Symptom Assessment