title: Hyperfractionated Accelerated Reirradiation for Patients With Recurrent Anal Cancer Previously Treated With Definitive Chemoradiation.
abstract: Although chemoradiation is the standard of care for anal cancer, limited data exist regarding pelvic reirradiation (re-RT) for recurrent disease. We investigated toxicity and outcomes in patients who received prior pelvic radiation therapy (RT), and subsequently underwent hyperfractionated accelerated re-RT to the pelvis for recurrent anal cancer.
  
  
  
  We reviewed records of 10 patients with recurrent anal squamous cell carcinoma who previously received pelvic RT to at least 30 Gy as a component of their chemoradiation and underwent re-RT in 1.5 Gy twice daily fractions to the pelvis, with either preoperative (N=7) or definitive (N=3) intent.
  
  
  
  The 3-year disease-free survival and 3-year overall survival rates were 40% and 60%. Four patients recurred within the reirradiated field, with a 3-year freedom from local progression rate of 56%. Of the 7 patients treated with preoperative intent, 5 proceeded to surgery, of whom 3 are alive and disease-free at a median duration of 43 months. Of the 3 patients treated definitively with no surgery, all are alive and disease-free at a median duration of 84 months. Re-RT resulted in one grade 3 acute toxicity and no grade 3 or higher late complications.
  
  
  
  Hyperfractionated accelerated re-RT was well-tolerated in patients with previously irradiated anal cancer. Patients treated with either definitive re-RT or re-RT followed by surgical resection had excellent rates of overall survival and freedom from local progression.
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Osborne
authors.affiliation: Medical Oncology.
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
authors.affiliation: Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: John M
authors.initials: JM
authors.lastname: Skibber
authors.affiliation: Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rodriguez-Bigas
authors.affiliation: Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: George J
authors.initials: GJ
authors.lastname: Chang
authors.affiliation: Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Yi-Qian
authors.initials: YQ
authors.lastname: Nancy You
authors.affiliation: Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Bednarski
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Minsky
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Delclos
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Eugene
authors.initials: E
authors.lastname: Koay
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
mesh_terms: D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*; D010386:Pelvic Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000556:secondary; D011379:Prognosis; D000069475:Re-Irradiation / Q000379:methods*; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology