Treatment of primary rectal adenocarcinoma after prior pelvic radiation: The role of hyperfractionated accelerated reirradiation

Garrett Jensen, MD; Randa Tao, MD; Cathy Eng, MD; John M. Skibber, MD; Miguel Rodriguez-Bigas, MD; George J. Chang, MD; Y. Nancy You, MD; Brian K. Bednarski, MD; Bruce D. Minsky, MD; Eugene Koay, MD, PhD; Cullen Taniguchi, MD, PhD; Sunil Krishnan, MD; Prajnan Das, MD, MS, MPH

Advances in Radiation Oncology (Oct 2018)

Treatment of primary rectal adenocarcinoma after prior pelvic radiation: The role of hyperfractionated accelerated reirradiation

Garrett Jensen, MD,
Randa Tao, MD,
Cathy Eng, MD,
John M. Skibber, MD,
Miguel Rodriguez-Bigas, MD,
George J. Chang, MD,
Y. Nancy You, MD,
Brian K. Bednarski, MD,
Bruce D. Minsky, MD,
Eugene Koay, MD, PhD,
Cullen Taniguchi, MD, PhD,
Sunil Krishnan, MD,
Prajnan Das, MD, MS, MPH

Affiliations

Garrett Jensen, MD: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
Randa Tao, MD: Department of Radiation Oncology, The University of Utah, Salt Lake City, Utah; Corresponding author: Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope, Room 1570, Salt Lake City, UT 84112.
Cathy Eng, MD: Department of Gastrointestinal Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
John M. Skibber, MD: Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
Miguel Rodriguez-Bigas, MD: Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
George J. Chang, MD: Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
Y. Nancy You, MD: Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
Brian K. Bednarski, MD: Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
Bruce D. Minsky, MD: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
Eugene Koay, MD, PhD: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
Cullen Taniguchi, MD, PhD: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
Sunil Krishnan, MD: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
Prajnan Das, MD, MS, MPH: Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas

Journal volume & issue: Vol. 3, no. 4
pp. 595 – 600

Abstract

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Purpose: Previous studies have reported that hyperfractionated accelerated reirradiation can be used as part of multimodality treatment of locally recurrent rectal cancer with acceptable toxicity and promising outcomes. The purpose of this study was to evaluate the outcomes and toxicity of hyperfractionated accelerated reirradiation for patients with primary rectal adenocarcinoma and a history of prior pelvic radiation for other primary malignancies. Methods and materials: We identified 10 patients with a prior history of pelvic radiation for other primary malignancies who were treated with hyperfractionated accelerated reirradiation for primary rectal adenocarcinoma. Radiation therapy was administered with 1.5 Gy twice daily fractions to a total dose of 39 Gy to 45Gy. Results: The median follow-up time was 3.2 years (range, 0.6-9.0 years). Seven of 10 patients received surgery after reirradiation. The 3-year freedom-from-local-progression rate was 62% for all patients and 80% for patients who underwent surgery. The 3-year overall survival rate was 100%, with 3 deaths occurring at 4.7, 6.5, and 9.0 years after reirradiation. One patient had an acute Grade 3 toxicity of diarrhea, and 1 patient experienced a late Grade 3 toxicity of sacral insufficiency fracture. Conclusions: Hyperfractionated accelerated reirradiation was well tolerated with promising rates of freedom from local progression and overall survival in patients with primary rectal cancer with a history of prior pelvic radiation therapy. This approach, along with concurrent chemotherapy and surgery, appears to be a viable treatment strategy for this patient population.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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