Palliative radiotherapy in patients with a symptomatic pelvic mass of metastatic colorectal cancer

Sun Hyun Bae,Woo Yong Lee,Won Ki Kang,Young Suk Park,Seong Hyeon Yun,Won Park,Hee Cheol Kim,Heerim Nam,Doo Ho Choi,Joon Oh Park,Ho Kyung Chun

doi:10.1186/1748-717x-6-52

Abstract

BackgroundTo evaluate the palliative role of radiotherapy (RT) and define the effectiveness of chemotherapy combined with palliative RT (CCRT) in patients with a symptomatic pelvic mass of metastatic colorectal cancer.MethodsFrom August 1995 to December 2007, 80 patients with a symptomatic pelvic mass of metastatic colorectal cancer were treated with palliative RT at Samsung Medical Center. Initial presenting symptoms were pain (68 cases), bleeding (18 cases), and obstruction (nine cases). The pelvic mass originated from rectal cancer in 58 patients (73%) and from colon cancer in 22 patients (27%). Initially 72 patients (90%) were treated with surgery, including 64 complete local excisions; 77% in colon cancer and 81% in rectal cancer. The total RT dose ranged 8-60 Gy (median: 36 Gy) with 1.8-8 Gy per fraction. When the α/β for the tumor was assumed to be 10 Gy for the biologically equivalent dose (BED), the median RT dose was 46.8 Gy10 (14.4-78). Twenty one patients (26%) were treated with CCRT. Symptom palliation was assessed one month after the completion of RT.ResultsSymptom palliation was achieved in 80% of the cases. During the median follow-up period of five months (1-44 months), 45% of the cases experienced reappearance of symptoms; the median symptom control duration was five months. Median survival after RT was six months. On univariate analysis, the only significant prognostic factor for symptom control duration was BED ≥40 Gy10 (p < 0.05), and CCRT was a marginally significant factor (p = 0.0644). On multivariate analysis, BED and CCRT were significant prognostic factors for symptom control duration (p < 0.05).ConclusionsRT was an effective palliation method in patients with a symptomatic pelvic mass of metastatic colorectal cancer. For improvement of symptom control rate and duration, a BED ≥ 40 Gy10 is recommended when possible. Considering the low morbidity and improved symptom palliation, CCRT might be considered in patients with good performance status.

Highlights

To evaluate the palliative role of radiotherapy (RT) and define the effectiveness of chemotherapy combined with palliative RT (CCRT) in patients with a symptomatic pelvic mass of metastatic colorectal cancer
Local control has been improved with adjuvant chemotherapy and radiotherapy (RT), approximately 10-25% of patients still develop recurrence of disease in the pelvis [5,6,7]
We evaluated the palliative role of RT and defined the effectiveness of chemotherapy combined with palliative RT in patients with a symptomatic pelvic mass of metastatic colorectal cancer

Summary

Introduction

To evaluate the palliative role of radiotherapy (RT) and define the effectiveness of chemotherapy combined with palliative RT (CCRT) in patients with a symptomatic pelvic mass of metastatic colorectal cancer. Local control has been improved with adjuvant chemotherapy and radiotherapy (RT), approximately 10-25% of patients still develop recurrence of disease in the pelvis [5,6,7]. Kleespies et al reported that palliative resection was associated with a unfavorable outcome in rectal cancer patients presenting with locally advanced lesion expected macroscopic residual tumor or an extensive comorbidity [10]. Patients with prior curative resection of colorectal cancer often present with pelvic pain, one of the common manifestations of local recurrence involving nerves in the presacrum or pelvic sidewalls. Resection of symptomatic pelvic tumor may be warranted only in those with adequate performance status and a resectable tumor burden with a possibly negative resection margin

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