Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: A multicentric phase II study

Valentini, Vincenzo; Morganti, Alessio Giuseppe; Gambacorta, Maria Antonietta; Mohiuddin, Mohammed; Doglietto, G. B.; Coco, Claudio; Paoli, Antonino De; Rossi, Carlo Riccardo; Russo, Anna; Valvo, Francesca; Bolzicco, Giampaolo; Palma, Maurizio Dalla

doi:10.1016/j.ijrobp.2005.09.017

Cited by 198 publications

(199 citation statements)

References 21 publications

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“…Therefore, employing a hyperfractionated radiotherapy schedule where lower doses per fraction are delivered twice a day, i.e., 1.2 Gy bidaily, compared to a larger fraction size once a day, i.e., 2 Gy daily, would allow preferential sparing of normal tissue while allowing the same tumoricidal dose to be delivered to the target volume. This strategy has been successfully employed in reirradiation of pelvic malignancies 23,24 and could potentially be exploited in the setting where reconstructive surgery is anticipated.…”

Section: Discussionmentioning

confidence: 99%

Urological reconstruction after pelvic oncological surgery: A single institution experience

Tan

et al. 2017

Asian Journal of Surgery

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Summary Background: In locally advanced pelvic malignancies, there is often involvement of urological organs, necessitating resection and reconstruction, which can be associated with significant complications. Methods: We retrospectively reviewed 20 patients undergoing urological reconstructions during pelvic oncological surgeries from January 2004 to December 2013. All patients had imagingproven involvement of at least one urological organ preoperatively. Primary outcome was urological complication rate. Secondary outcomes were nonurological complication, recurrence rate, and overall survival. Results: Median age of presentation was 51 years. Six and 14 patients underwent resections for primary and secondary tumors, respectively. Colorectal tumors were the most common, followed by gynecological cancers. The ureter was the most common urological organ involved, followed by the bladder, prostate, and seminal vesicles. Reconstructive procedures included ileal and sigmoid conduits, ureteroneocystostomies, Boari flap, transureteroureterostomies (TUUs) and direct ureteroureterostomies. Six patients developed major urological complications, requiring endoscopic and surgical reinterventions. The follow-up time was 34 months. Thirteen patients developed recurrence, associated with higher tumor grade and lymphovascular invasion, and occurred at a median time of 10 months. These patients had an overall survival of 20 months, compared to 45 months in patients without recurrence. Conclusion: Careful patient selection in pelvic oncological surgeries can significantly prolong survival. Recurrent tumors and greater intraoperative blood loss are associated with higher urological complications. A limited pelvic exenteration and lower radiation doses can reduce

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Section: Discussionmentioning

confidence: 99%

Urological reconstruction after pelvic oncological surgery: A single institution experience

Tan

et al. 2017

Asian Journal of Surgery

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“…[17] Hipertermi veya (intraoperatif RT) IORT ile birlikte yapılabilen tekrar radyoterapisi ve cerrahi birlikteliğinde beş yıllık sağkalım %40, grade III toksisite %5-15'ten az olarak bildirilmiştir [31][32][33] Cerrahiyle birlikte IORT kullanımında makul lokal kontrol oranlarının bildirildiği birçok çalışma mevcuttur. [34][35][36][37][38] Ancak daha yakın bir zamanda yayınlanan bir olgu çalışmasında lokal başarısızlık oranı %53 gibi yüksek bir oranda bildirilmiştir.…”

Section: Discussionunclassified

Is stereotactic body radiotherapy a treatment option for pelvic recurrences?

Dağoğlu¹

2015

TJ Oncol

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KliNiK ÇalIŞma ORIGINAL ARTICLE oBJeCtIVeSWhen surgery is not adequate, stereotactic body radiotherapy (SBRT) has been used for recurrent cancers. We report the outcomes of case series with pelvic recurrences from colorectal cancer irradiated with SBRT. metHoDSRobotic Stereotactic Radiotherapy system was used. The dose fractionation scheme was individualized based on tumor volume and location and prior radiation dose. reSultSBetween February 2010 and December 2014, four patients were treated. Treatment regions were pelvic side wall for two patients and presacral for two patients. SBRT doses were 24 Gy in 3 fractions for three patients and 36.25 Gy in 5 fractions for one patient.One patient treated for pelvic side wall recurrence developed symptomatic noropathy at fist year. CoNCluSIoNLocal recurrence in pelvis after modern combined modality treatment for colorectal cancer is rare. However it presents a therapeutic dilemma when it occurs; often symptomatic and eventually life threatening. SBRT can be a useful modality in this setting.

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“…4,7,17,20,25,29,34,40,44,45,47 Included patients had undergone EBRT as part of the primary treatment in a median of 28% (range 0%-100%) of cases in 43 studies (Table 1). Previous radiotherapy dose was specified in 10 studies, 4,7,9,12,19,27,28,41,55,57 with a total dose ranging from 10 to 110 Gy. The median percentage of patients who underwent chemotherapy as part of the treatment for the primary tumour was 37% (range 0%-100%) in 21 evaluable studies (Table 1).…”

Section: Therapy For Primary Rectal Cancermentioning

confidence: 99%

“…Radiotherapy dose was specified in 28 studies. [3][4][5][6][7][8][9]11,18,19,28,29,30,[33][34][35][36][37]41,44,46,47,[50][51][52][53]56,57 Without prior EBRT, the total dose was 40-60 Gy in most studies, with an overall range of 15-80 Gy. Conventional fractionation (1.8-2.0 Gy per fraction) was uniformly applied in 13 studies, 3,6,7,9,11,18,19,28,30,36,46,50,52 and selective use of a hypofractionated schedule (fractions of 5 Gy) was described in 2 studies.…”

Section: Perioperative Treatment For Local Recurrencementioning

confidence: 99%

“…External beam radiotherapy was part of a chemoradiotherapy regimen, mostly fluorouracil-based, in 27 studies (Table 2); routine use of chemoradiotherapy was reported in only 3 studies. 18,27,41 Intraoperative radiotherapy (IORT) was routinely used as part of the treatment protocol in 7 studies; in another CT = adjuvant systemic chemotherapy; CRT = concurrent chemotherapy during EBRT as percentage of total resections; EBRT = external beam radiotherapy; IORT = intraoperative radiotherapy; Postop = postoperative; Preop = preoperative; re-EBRT = EBRT for both primary tumour and local recurrence; Sacral = abdominosacral resection. *Multicentre study: Bussières 6 centres, 7 Valentini 12, 41 Palmer 9, 44 Wells 2, 45 Heriot 3.…”

Section: Perioperative Treatment For Local Recurrencementioning

confidence: 99%

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Intentionally curative treatment of locally recurrent rectal cancer: a systematic review

Tanis

Doeksen

Lanschot

2013

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Intentionally curative treatment of locally recurrent rectal cancer: a systematic reviewBackground: There is a lack of outcome data beyond local recurrence rates after primary treatment in rectal cancer, despite more information being necessary for clinical decision-making. We sought to determine patient selection, therapeutic modalities and outcomes of locally recurrent rectal cancer treated with curative intent. Methods:We searched MEDLINE (1990-2010) using the medical subject headings "rectal neoplasms" and "neoplasm recurrence, local." Selection of cohort studies was based on the primary intention of treatment and availability of at least 1 outcome variable. Results:We included 55 cohort studies comprising 3767 patients; 8 studies provided data on the rate of intentionally curative treatment from an unselected consecutive cohort of patients (481 of 1188 patients; 40%). Patients were symptomatic with pain in 50% (796 of 1607) of cases. Overall, 3088 of 3767 patients underwent resection. The R0 resection rate was 56% (1484 of 2637 patients). The rate of external beam radiotherapy was 100% in 9 studies, 0% in 5 studies, and ranged from 12% to 97% in 37 studies. Overall postoperative mortality was 2.2% (57 of 2515 patients). Five-year survival was at least 25%, with an upper limit of 41% in 11 of 18 studies including at least 50 resections. We found a significant increase in reported survival rates over time (r 2 = 0.214, p = 0.007). Conclusion:More uniformity in treatment protocols and reporting on outcomes for locally recurrent rectal cancer is warranted. The observed improvement of reported survival rates in time is probably related to better patient selection and optimized multimodality treatment in specialized centres.

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Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: A multicentric phase II study

Cited by 198 publications

References 21 publications

Urological reconstruction after pelvic oncological surgery: A single institution experience

Urological reconstruction after pelvic oncological surgery: A single institution experience

Is stereotactic body radiotherapy a treatment option for pelvic recurrences?

Intentionally curative treatment of locally recurrent rectal cancer: a systematic review

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