Randa Tao1, Chiaojung Jillian Tsai2, Garrett Jensen3, Cathy Eng4, Scott Kopetz4, Michael J Overman4, John M Skibber5, Miguel Rodriguez-Bigas5, George J Chang5, Yi-Qian Nancy You5, Brian K Bednarski5, Bruce D Minsky3, Marc E Delclos3, Eugene Koay3, Sunil Krishnan3, Christopher H Crane2, Prajnan Das3. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, USA. Electronic address: randa.tao@hci.utah.edu. 2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 4. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 5. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Abstract
BACKGROUND AND PURPOSE: To evaluate outcomes and toxicity in patients treated with hyperfractionated pelvic reirradiation for recurrent rectal cancer. MATERIALS AND METHODS: 102 patients with recurrent rectal adenocarcinoma were treated with pelvic reirradiation with a hyperfractionated accelerated approach, consisting of 1.5Gy twice daily fractions to a total dose of 30-45Gy (median 39Gy), with the most common total dose 39Gy (n=90, 88%). The median dose of prior pelvic radiation therapy (RT) was 50.4Gy (range: 25-63Gy). RESULTS: The median follow-up was 40months for living patients (range, 3-150months). The 3-year freedom from local progression (FFLP) rate was 40% and the 3-year overall survival (OS) rate was 39%. Treatment with surgery was significantly associated with improved FFLP and OS, with 3-year FFLP rate of 49% vs. 30% (P=0.013), and 3-year OS rate of 62% vs. 20% (P<0.0001), compared to those without surgery. The actuarial 3-year rate of grade 3-4 late toxicity was 34%; patients who underwent surgery had a significantly higher rate of grade 3-4 late toxicity compared to those without surgery (54% vs. 16%, P=0.001). CONCLUSIONS: This large, retrospective, single-institution study shows that hyperfractionated accelerated reirradiation was well tolerated. The rate of FFLP was promising, given that the study comprised heavily pre-treated patients with recurrences. Rates of FFLP and OS were particularly impressive in patients who underwent both reirradiation and surgery. Published by Elsevier B.V.
BACKGROUND AND PURPOSE: To evaluate outcomes and toxicity in patients treated with hyperfractionated pelvic reirradiation for recurrent rectal cancer. MATERIALS AND METHODS: 102 patients with recurrent rectal adenocarcinoma were treated with pelvic reirradiation with a hyperfractionated accelerated approach, consisting of 1.5Gy twice daily fractions to a total dose of 30-45Gy (median 39Gy), with the most common total dose 39Gy (n=90, 88%). The median dose of prior pelvic radiation therapy (RT) was 50.4Gy (range: 25-63Gy). RESULTS: The median follow-up was 40months for living patients (range, 3-150months). The 3-year freedom from local progression (FFLP) rate was 40% and the 3-year overall survival (OS) rate was 39%. Treatment with surgery was significantly associated with improved FFLP and OS, with 3-year FFLP rate of 49% vs. 30% (P=0.013), and 3-year OS rate of 62% vs. 20% (P<0.0001), compared to those without surgery. The actuarial 3-year rate of grade 3-4 late toxicity was 34%; patients who underwent surgery had a significantly higher rate of grade 3-4 late toxicity compared to those without surgery (54% vs. 16%, P=0.001). CONCLUSIONS: This large, retrospective, single-institution study shows that hyperfractionated accelerated reirradiation was well tolerated. The rate of FFLP was promising, given that the study comprised heavily pre-treated patients with recurrences. Rates of FFLP and OS were particularly impressive in patients who underwent both reirradiation and surgery. Published by Elsevier B.V.
Authors: Amelia Barcellini; Viviana Vitolo; Lorenzo Cobianchi; Andrea Peloso; Alessandro Vanoli; Alfredo Mirandola; Angelica Facoetti; Maria Rosaria Fiore; Alberto Iannalfi; Barbara Vischioni; Francesco Cuccia; Sara Ronchi; Maria Bonora; Giulia Riva; Rachele Petrucci; Emma D'Ippolito; Francesca Dal Mas; Lorenzo Preda; Francesca Valvo Journal: In Vivo Date: 2020 May-Jun Impact factor: 2.155
Authors: Shalini Moningi; Ethan B Ludmir; Praveen Polamraju; Tyler Williamson; Marcella M Melkun; Joseph D Herman; Sunil Krishnan; Eugene J Koay; Albert C Koong; Bruce D Minsky; Grace L Smith; Cullen Taniguchi; Prajnan Das; Emma B Holliday Journal: Clin Transl Radiat Oncol Date: 2019-08-27
Authors: Andrew Hunt; Prajnan Das; Bruce D Minsky; Eugene J Koay; Sunil Krishnan; Joseph M Herman; Cullen Taniguchi; Albert Koong; Grace L Smith; Emma B Holliday Journal: Radiat Oncol Date: 2018-08-07 Impact factor: 3.481
Authors: Garrett Jensen; Randa Tao; Cathy Eng; John M Skibber; Miguel Rodriguez-Bigas; George J Chang; Y Nancy You; Brian K Bednarski; Bruce D Minsky; Eugene Koay; Cullen Taniguchi; Sunil Krishnan; Prajnan Das Journal: Adv Radiat Oncol Date: 2018-07-17