Abstract
PurposeStereotactic body radiation therapy (SBRT) has emerged as a potential therapeutic option for locally recurrent rectal cancer (LRRC) but contemporaneous clinical data are limited. We aimed to evaluate the local control, toxicity, and survival outcomes in a cohort of patients previously treated with neoadjuvant pelvic radiation therapy for nonmetastatic locally recurrent rectal cancer, now treated with SBRT. Methods and MaterialsInoperable rectal cancer patients with ≤3 sites of pelvic recurrence and >6 months since prior pelvic radiation therapy were identified from a prospective registry over 4 years. SBRT dose was 30 Gy in 5 fractions, daily or alternate days, using cumulative organ at risk dose constraints. Primary outcome was local control (LC). Secondary outcomes were progression free survival, overall survival, toxicity, and patient reported quality of life scores using the EQ visual analog scale (EQ-VAS) tool. ResultsThirty patients (35 targets) were included. Median gross tumor volume size was 14.3 cm3. In addition, 27 of 30 (90%) previously received 45 to 50.4 Gy in 25 of 28 fractions, with 10% receiving an alternative prescription. All patients received the planned reirradiation SBRT dose. The median follow-up was 24.5 months (interquartile range, 17.8-28.8). The 1-year LC was 84.9% (95% confidence interval [CI], 70.6-99) and a 2-year LC was 69% (95% CI, 51.8-91.9). The median progression free survival was 12.1 months (95% CI, 8.6-17.66), and median overall survival was 28.3 months (95% CI, 17.88-39.5 months). No patient experienced >G2 acute toxicity and only 1 patient experienced late G3 toxicity. Patient-reported QoL outcomes were improved at 3 months after SBRT (Δ EQ-VAS, +10 points, Wilcoxon signed-rank, P = .009). ConclusionsOur study demonstrates that, for small volume pelvic disease relapses from rectal cancer, reirradiation with 30 Gy in 5 fractions is well tolerated and achieves an excellent balance between high local control rates with limited toxicity.
Highlights
Recurrent rectal cancer (LRRC) is defined as recurrence of rectal cancer within the pelvis after previous surgical resection.[1]
Patients were all discussed at a colorectal specialist multidisciplinary meeting for surgery and only inoperable patients, with less than 3 metastases, who had a disease-free survival of at least 6 months, World Health Organization performance status 0 to 2, and greater than 6 months since previous radiation therapy were considered suitable for Stereotactic body radiation therapy (SBRT) reirradiation
All patients received the intended dose of 30 Gy in 5 fractions and the Organs at risk (OARs) constraints were respected in all cases
Summary
Recurrent rectal cancer (LRRC) is defined as recurrence of rectal cancer within the pelvis after previous surgical resection.[1] Local recurrence rates remain approximately 10% and the majority of those that recur will have received neo adjuvant (chemo) radiation therapy as part of initial multimodality treatment.[2,3,4] Prognosis is poor with significant morbidity and poor quality of life from pelvic pain, fistula, bleeding, and fecal discharge.[5] Untreated LRRC has a median survival of 6 months, improving with chemotherapy or radiation 12 to 16 months.[6]. Pelvic exenteration is associated with significant morbidity and not always feasible.[8,9] There is no clear consensus about which cases should go for resection
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