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The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer.

Publication ,  Journal Article
Susko, M; Lee, J; Salama, J; Thomas, S; Uronis, H; Hsu, D; Migaly, J; Willett, C; Czito, B; Palta, M
Published in: Ann Surg Oncol
October 2016

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

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Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

October 2016

Volume

23

Issue

11

Start / End Page

3609 / 3615

Location

United States

Related Subject Headings

  • Symptom Assessment
  • Survival Rate
  • Retreatment
  • Rectal Neoplasms
  • Radiotherapy, Intensity-Modulated
  • Palliative Care
  • Oncology & Carcinogenesis
  • Neoplasm, Residual
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
 

Citation

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Susko, M., Lee, J., Salama, J., Thomas, S., Uronis, H., Hsu, D., … Palta, M. (2016). The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer. Ann Surg Oncol, 23(11), 3609–3615. https://doi.org/10.1245/s10434-016-5250-z
Susko, Matthew, Jason Lee, Joseph Salama, Samantha Thomas, Hope Uronis, David Hsu, John Migaly, Christopher Willett, Brian Czito, and Manisha Palta. “The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer.Ann Surg Oncol 23, no. 11 (October 2016): 3609–15. https://doi.org/10.1245/s10434-016-5250-z.
Susko M, Lee J, Salama J, Thomas S, Uronis H, Hsu D, et al. The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer. Ann Surg Oncol. 2016 Oct;23(11):3609–15.
Susko, Matthew, et al. “The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer.Ann Surg Oncol, vol. 23, no. 11, Oct. 2016, pp. 3609–15. Pubmed, doi:10.1245/s10434-016-5250-z.
Susko M, Lee J, Salama J, Thomas S, Uronis H, Hsu D, Migaly J, Willett C, Czito B, Palta M. The Use of Re-irradiation in Locally Recurrent, Non-metastatic Rectal Cancer. Ann Surg Oncol. 2016 Oct;23(11):3609–3615.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

October 2016

Volume

23

Issue

11

Start / End Page

3609 / 3615

Location

United States

Related Subject Headings

  • Symptom Assessment
  • Survival Rate
  • Retreatment
  • Rectal Neoplasms
  • Radiotherapy, Intensity-Modulated
  • Palliative Care
  • Oncology & Carcinogenesis
  • Neoplasm, Residual
  • Neoplasm Staging
  • Neoplasm Recurrence, Local