Re-irradiation With Carbon Ion Radiotherapy for Pelvic Rectal Cancer Recurrences in Patients Previously Irradiated to the Pelvis

Barcellini, Amelia; Vitolo, Viviana; Cobianchi, Lorenzo; Peloso, Andréa; Vanoli, Alessandro; Mirandola, A.; Facoetti, Angelica; Fiore, Maria Rosaria; Iannalfi, Alberto; Vischioni, Barbara; Cuccia, Francesco; Ronchi, Sara; Bonora, Maria; Riva, Giulia; Petrucci, R.; D’Ippolito, E.; Mas, Francesca Dal; Preda, Lorenzo; Valvo, Francesca

doi:10.21873/invivo.11944

Cited by 17 publications

(40 citation statements)

References 29 publications

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“…Moreover, in addition to results for R0 resection rate, our study will provide strong data about tolerance of reirradiation, which remain scarce in a prospective setting. There are, a number of radiotherapy techniques available for use in LRRC, with varying evidence for the use of intensity‐modulated radiotherapy, stereotactic ablative body radiotherapy [23], carbon ion radiotherapy [24,25], intraoperative radiotherapy [26] and proton beam radiotherapy [27]. There is huge potential for future radiotherapy trials in LRRC to build on the robust trial data which GRECCAR 15 will deliver to explore the optimal radiotherapy dose, timing, volumes and radiotherapy techniques with the aim of maximizing radiotherapy treatments and personalizing care in this heterogeneous cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

A phase III randomized trial evaluating chemotherapy followed by pelvic reirradiation versus chemotherapy alone as preoperative treatment for locally recurrent rectal cancer – GRECCAR 15 trial protocol

et al. 2021

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Aim: Treatment strategies in locally recurrent rectal cancer (LRRC) are complex and need to be balanced against previous treatments received for the primary rectal cancer.Radiotherapy is an important component of treatment in LRRC. However, there is little high-quality evidence on the role of reirradiation in this cohort. Therefore, the aim of this trial is to assess the efficacy of neoadjuvant chemotherapy followed by pelvic reirradiation versus neoadjuvant chemotherapy alone on the rate of curative surgery (R0) in previously irradiated patients with LRRC.Method: GRECCAR 15 is a prospective, multicentre, open-label, outcome assessorblinded, superiority randomized controlled phase III clinical trial comparing neoadjuvant chemotherapy followed by pelvic reirradiation versus neoadjuvant chemotherapy alone in patients with LRRC previously irradiated for the primary cancer. Adult patients (>18 years old) with a histologically proven resectable LRRC, who have previously received pelvic radiotherapy for their primary rectal cancer at a dose of 25-50.4 Gy, and an Eastern Cooperative Oncology Group performance status of <2 will be eligible to participate. The pelvic reirradiation will consist of conformational intensity-modulated external irradiation, delivering a dose of 30.6 Gy with concomitant chemotherapy using capecitabine.The primary outcome of this trial is the R0 resection rate. Overall, GRECCAR 15 aims to recruit 186 patients to detect an absolute difference of 20% in the R0 resection rate with 80% power and 5% two-sided significance level. Conclusion:The GRECCAR 15 trial is the first, definitive, phase III trial to investigate reirradiation in LRRC. The results of this trial will inform definitively the neoadjuvant treatment strategy in previously irradiated patients and assess whether there is any associated benefit of reirradiation in combination with induction chemotherapy in improving R0 resection rates.

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Section: Discussionmentioning

confidence: 99%

A phase III randomized trial evaluating chemotherapy followed by pelvic reirradiation versus chemotherapy alone as preoperative treatment for locally recurrent rectal cancer – GRECCAR 15 trial protocol

et al. 2021

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“…Regarding reirradiation with CIRT for pelvic tumors, Barcellini et al [27] reported that 14 patients with recurrent rectal cancer after radiotherapy underwent CIRT and none of them experienced grade ≥3 toxicities. In our series, 2 patients underwent CIRT for pelvic RAS.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of 20 Cases of Radiation-Associated Sarcoma, Including 4 Cases Treated by Carbon Ion Radiotherapy

et al. 2021

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Introduction Radiation-associated sarcoma (RAS) is one of the most life-threatening complications associated with the treatment of malignant neoplasms. Because all RAS patients have a history of radiotherapy, there have been no effective treatment options when RAS is not completely resected. Methods We retrospectively reviewed 20 RAS patients, including 4 unresectable cases treated by carbon ion radiotherapy (CIRT). Results The primary diseases targeted by radiotherapy included malignant lymphoma (n=4), cervical cancer (n=3), pharyngeal cancer (n=3), breast cancer (n=2), lung cancer (n=1), rectal cancer (n=1), maxillary cancer (n=1), synovial sarcoma (n=1), and benign neoplasms (n=4). The histological diagnoses of RAS included osteosarcoma (n=8), leiomyosarcoma (n=3), undifferentiated pleomorphic sarcoma (n=3), rhabdomyosarcoma (n=1), angiosarcoma (n=1), malignant peripheral nerve sheath tumor (n=1), spindle cell sarcoma NOS (n=1), and sarcoma not further specified (n=2). The median survival time from the diagnosis of RAS was 26 months. Eleven patients underwent surgery. Five of these patients achieved a continuous disease free status or showed no evidence disease. Four patients underwent CIRT. One of these patients with leiomyosarcoma achieved a continuous disease free status, and the other patient with osteosarcoma achieved a partial response. On the other hand, 2 patients experienced Grade 3 toxicities that required surgical treatment. Conclusion RAS originates from various types of diseases that are treated by radiotherapy and shows diverse pathological features. Complete resection achieves a good prognosis. CIRT can be an effective and feasible option for unresectable RAS.

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“…Further, fractionated SBRT might be more advantageous because it allows the re-oxygenation of hypoxic tumour cells and redistribution of resistant tumour cells into more radiosensitive cell cycle phases. 108 Heavy particles, by protons and carbon ions, are emerging as promising treatment RT modality in radioresistant cancers, [109][110][111][112][113][114][115][116] such as pancreatic tumours. [117][118][119][120][121] Proton therapy, thanks to its intrinsic physical selectivity, allows delivering dose to the target with no exit dose in the beam path.…”

Section: Radiotherapymentioning

confidence: 99%

<p>Locally Advanced Pancreatic Ductal Adenocarcinoma: Challenges and Progress</p>

Barcellini¹,

Peloso²,

Pugliese³

et al. 2020

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Pancreatic ductal adenocarcinoma (PDAC) is one of the major causes of death in the Western world, and it is estimated to become the second leading cause of tumour-related mortality in the next 10 years. Among pancreatic cancers, ductal adenocarcinomas are by far the most common, characterised by a challenging diagnosis due to the lack of initial and pathognomonic clinical signs. In this scenario, non-metastatic locally advanced pancreatic cancer (LAPC) accounts for a large proportion of all new pancreatic ductal adenocarcinoma diagnoses. There is no consensus on a common definition of LAPC. Still, it usually includes tumours that are not resectable due to vascular involvement. As of today, treatment is limited, and the prognosis is very unfavourable. Curative-intent surgery remains the gold-standard even if often jeopardized by vascular involvement. Continuing progress in our understanding of LAPC genetics and immunology will permit the development of different treatments, targeted or combined, including radiation therapy, hadrontherapy, targeted immunotherapies or new chemotherapies. A multidisciplinary approach combining various fields of expertise is essential in aiming to limit disease progression as well as patient outcome. Using a narrative literature review approach, the manuscript explores the most up-to-date knowledge concerning locally advanced pancreatic ductal adenocarcinoma management.

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Re-irradiation With Carbon Ion Radiotherapy for Pelvic Rectal Cancer Recurrences in Patients Previously Irradiated to the Pelvis

Cited by 17 publications

References 29 publications

A phase III randomized trial evaluating chemotherapy followed by pelvic reirradiation versus chemotherapy alone as preoperative treatment for locally recurrent rectal cancer – GRECCAR 15 trial protocol

A phase III randomized trial evaluating chemotherapy followed by pelvic reirradiation versus chemotherapy alone as preoperative treatment for locally recurrent rectal cancer – GRECCAR 15 trial protocol

An Analysis of 20 Cases of Radiation-Associated Sarcoma, Including 4 Cases Treated by Carbon Ion Radiotherapy

<p>Locally Advanced Pancreatic Ductal Adenocarcinoma: Challenges and Progress</p>

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