Louise Janet Murray1, John Lilley2, Maria A Hawkins3, Ann M Henry4, Peter Dickinson5, David Sebag-Montefiore4. 1. Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, UK. Electronic address: L.J.Murray@leeds.ac.uk. 2. Department of Medical Physics, Leeds Cancer Centre, St James's University Hospitals, UK. 3. CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK. 4. Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, UK. 5. Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, UK.
Abstract
BACKGROUND AND PURPOSE: To perform a systematic review regarding the use of stereotactic ablative radiotherapy (SABR) for the re-irradiation of recurrent malignant disease within the pelvis, to guide the clinical implementation of this technique. MATERIAL AND METHODS: A systematic search strategy was adopted using the MEDLINE, EMBASE and Cochrane Library databases. RESULTS: 195 articles were identified, of which 17 were appropriate for inclusion. Studies were small and data largely retrospective. In total, 205 patients are reported to have received pelvic SABR re-irradiation. Dose and fractionation schedules and re-irradiated volumes are highly variable. Little information is provided regarding organ at risk constraints adopted in the re-irradiation setting. Treatment appears well-tolerated overall, with nine grade 3 and six grade 4 toxicities amongst thirteen re-irradiated patients. Local control at one year ranged from 51% to 100%. Symptomatic improvements were also noted. CONCLUSIONS: For previously irradiated patients with recurrent pelvic disease, SABR re-irradiation could be a feasible intervention for those who otherwise have limited options. Evidence to support this technique is limited but shows initial promise. Based on the available literature, suggestions for a more formal SABR re-irradiation pathway are proposed. Prospective studies and a multidisciplinary approach are required to optimise future treatment.
BACKGROUND AND PURPOSE: To perform a systematic review regarding the use of stereotactic ablative radiotherapy (SABR) for the re-irradiation of recurrent malignant disease within the pelvis, to guide the clinical implementation of this technique. MATERIAL AND METHODS: A systematic search strategy was adopted using the MEDLINE, EMBASE and Cochrane Library databases. RESULTS: 195 articles were identified, of which 17 were appropriate for inclusion. Studies were small and data largely retrospective. In total, 205 patients are reported to have received pelvic SABR re-irradiation. Dose and fractionation schedules and re-irradiated volumes are highly variable. Little information is provided regarding organ at risk constraints adopted in the re-irradiation setting. Treatment appears well-tolerated overall, with nine grade 3 and six grade 4 toxicities amongst thirteen re-irradiated patients. Local control at one year ranged from 51% to 100%. Symptomatic improvements were also noted. CONCLUSIONS: For previously irradiated patients with recurrent pelvic disease, SABR re-irradiation could be a feasible intervention for those who otherwise have limited options. Evidence to support this technique is limited but shows initial promise. Based on the available literature, suggestions for a more formal SABR re-irradiation pathway are proposed. Prospective studies and a multidisciplinary approach are required to optimise future treatment.
Authors: Thomas Smith; Sean M O'Cathail; Sabrina Silverman; Maxwell Robinson; Yatman Tsang; Mark Harrison; Maria A Hawkins Journal: Adv Radiat Oncol Date: 2020-08-07
Authors: Gargi Kothari; Andrew Loblaw; Alison C Tree; Nicholas J van As; Drew Moghanaki; Simon S Lo; Piet Ost; Shankar Siva Journal: Technol Cancer Res Treat Date: 2018-01-01