Stereotactic body radiotherapy for the treatment of presacral recurrences from rectal cancers
Department of Radiation Oncology, Head and Neck Surgery, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232, USA. Journal of cancer research and therapeutics
(Impact Factor: 0.79).
10/2011; 7(4):408-11. DOI: 10.4103/0973-1482.92000
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.
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.
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.
Stereotactic body radiotherapy for presacral recurrence of rectal adenocarcinoma is an efficacious and well-tolerated treatment modality which allows for palliation of pain.
Available from: Morten Brændengen
- "Reirradiation has been combined with hyperthermia   and has also been delivered with brachytherapy  in patient series. SBRT for reirradiation poses an interesting possibility for delivering high doses to restricted volumes with very tight margins , although there are limited data for recurrent rectal cancer, SBRT has been used for presacral or pelvic wall recurrences  . Tumour classification according to the site of recurrence within the pelvis or according to degree of fixation, determined by preoperative imaging   , may be helpful for decisions in the multidisciplinary team (MDT) conference. "
[Show abstract] [Hide abstract]
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.
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.
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.
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.
Radiotherapy and Oncology 11/2014; 113(2). DOI:10.1016/j.radonc.2014.11.021 · 4.36 Impact Factor
Available from: Matthias Guckenberger
- "Defoe et al. analyzed 14 patients treated with SBRT for presacral recurrent adenocarcinoma of the rectum . All patients had been previously irradiated with a median of 50.4 Gy (range, 20 – 81 Gy). "
[Show abstract] [Hide abstract]
ABSTRACT: Although locoregional relapse is frequent after definitive radiotherapy (RT) or multimodal treatments, re-irradiation is only performed in few patients even in palliative settings like e.g. vertebral metastasis. This is most due to concern about potentially severe complications, especially when large volumes are exposed to re-irradiation. With technological advancements in treatment planning the interest in re-irradiation as a local treatment approach has been reinforced. Recently, several studies reported re-irradiation for spinal metastases using SBRT with promising local and symptom control rates and simultaneously low rates of toxicity. These early data consistently indicate that SBRT is a safe and effective treatment modality in this clinical situation, where other treatment alternatives are rare. Similarly, good results have been shown for SBRT in the re-irradiation of head and neck tumors. Despite severe late adverse effects were reported in several studies, especially after single fraction doses >10 Gy, they appear less frequently compared to conventional radiotherapy. Few studies with small patient numbers have been published on SBRT re-irradiation for non-small cell lung cancer (NSCLC). Overall survival (OS) is limited by systemic progression and seems to depend particularly on patient selection. SBRT re-irradiation after primary SBRT should not be practiced in centrally located tumors due to high risk of severe toxicity. Only limited data is available for SBRT re-irradiation of pelvic tumors: feasibility and acceptable toxicity has been described, suggesting SBRT as a complementary treatment modality for local symptom control.
Radiation Oncology 01/2013; 8(1):7. DOI:10.1186/1748-717X-8-7 · 2.55 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Radiation therapy has been used to treat cancers for over one hundred years. Over the last century our understanding of the biology of radiation exposure as well as our ability to safely deliver extraordinarily high doses of radiation to specific targets has led to its routine use in both curative and palliative settings for most solid tumors. External radiation beam techniques invariably involve irradiating normal tissues that are located between the radiation source and the intended target. High-energy linear accelerators have greatly reduced skin and subcutaneous radiation-induced injury; however, radiation tolerances of organs adjacent to the target do frequently limit the total amount of radiation that can be used. Intraoperative radiation therapy (IORT) can be delivered in a number of ways, with the ultimate intent of minimizing normal tissue exposure to potentially harmful doses of radiation. Multiple IORT delivery modalities are now available, all of which present potential advantages and disadvantages over other methods of treatment. The specific techniques, radiobiologic considerations, and clinical uses of IORT will be described.
Critical Reviews in Eukaryotic Gene Expression 12/2012; 22(4):269-79. DOI:10.1615/CritRevEukarGeneExpr.v22.i4.10 · 1.57 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.