Effect and safety of proton beam therapy for locally recurrent rectal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 743-743
Author(s):  
Yusuke Ogi ◽  
Tomohiro Yamaguchi ◽  
Yusuke Kinugasa ◽  
Akio Shiomi ◽  
Hiroyasu Kagawa ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Proton Beam ◽  
Survival Rates ◽  
Proton Beam Therapy ◽  
Local Control Rate ◽  
Recurrent Rectal Cancer ◽  
Lateral Lymph Node ◽  
Free Survival ◽  
Locally Recurrent Rectal Cancer ◽  
Locally Recurrent

743 Background: The first choice of treatment for locally recurrent rectal cancer is surgical resection. However, the operation is often difficult with high perioperative risk. For surgically unfit cases, proton beam therapy (PBT) is proposed as the treatment option. However, its efficacy for locally recurrent rectal cancer remains unclear. Therefore, this study aimed to evaluate the efficacy and safety of PBT for locally recurrent rectal cancer. Methods: A total of 23 patients with locally recurrent rectal cancer who received PBT were retrospectively evaluated, from November 2005 to July 2014. Patients with single lesion, who refuse the radical surgical therapy, or who were considered unfit for the operation were included in this study. All patients were treated with 2.8Gy relative biological effectiveness (RBE)/fraction. Twenty-five irradiations were performed, with a total irradiation of 70Gy RBE. Unfit for operation criteria include invasion to the vertebra higher than the third sacrum or lateral lymph node recurrence after a lateral lymph node dissection. To assess the safety of PBT, adverse events were evaluated by using the Common Terminology Criteria for Adverse Effects (CTCAE version4.0). To assess the efficacy, the overall and relapse-free survival rates and local control rate were evaluated. Results: Sixteen patients were unfit for operation, and seven refused surgery. Three patients experienced Grade 3 late adverse events in the CTCAE (two ileum fistula and one urinary tract obstruction). The median follow-up time was 28.9 months. The 5-year overall and relapse-free survival rates were 47.6% and 20.2%, respectively. Fifteen patients (65.2%) showed distant metastasis or regrowth at the locally recurrent site. The 5-year local control rate was 39.0%. Ten patients (43.4%) showed regrowth at the proton beam irradiation site. Conclusions: PBT was relatively effective for locally recurrent rectal cancer with manageable adverse effects. Therefore, PBT may be considered as the therapeutic option for selected locally recurrent rectal cancer patients.

scholarly journals A Case of Long-term Disease-free Survival after Radiotherapy for Locally Recurrent Rectal Cancer

2013 ◽  
Vol 66 (6) ◽  
pp. 416-421
Author(s):  
Nobuyoshi Yamazaki ◽  
Akihiro Kobayashi ◽  
Yusuke Nishizawa ◽  
Masaaki Ito ◽  
Masanori Sugito ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Disease Free Survival ◽  
Recurrent Rectal Cancer ◽  
Free Survival ◽  
Locally Recurrent Rectal Cancer ◽  
Locally Recurrent ◽  
Disease Free

A phase III randomized controlled trial comparing surgery plus adjuvant chemotherapy with or without preoperative chemoradiotherapy for locally recurrent rectal cancer: A Japan Clinical Oncology Group study (JCOG1801).

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. TPS263-TPS263
Author(s):  
Yuichiro Tsukada ◽  
Masaaki Ito ◽  
Naoki Nakamura ◽  
Yoshinori Ito ◽  
Hideaki Bando ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Preoperative Chemoradiotherapy ◽  
Local Relapse ◽  
Recurrent Rectal Cancer ◽  
Phase Iii ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Locally Recurrent Rectal Cancer ◽  
Locally Recurrent

TPS263 Background: Local recurrence is one of the most common forms of recurrence after curative resection for primary rectal cancer. Surgical resection is recommended for locally recurrent rectal cancer (LRRC) to achieve radical cure if the tumor is judged as resectable with negative margins. However, a high local re-recurrent risk after surgery is a major problem due to the difficulty of re-resection and the serious symptoms, such as pain or fistula, resulting from re-recurrence. Preoperative chemoradiotherapy (preCRT) is expected to improve local control after radical surgery for radiation naïve LRRC; however, high frequency of surgical complications after preCRT cannot be ignored. Due to the refractory nature and rarity of LRRC, the true impact of preCRT on oncological and surgical outcomes has not been clarified by clinical trials. The purpose of this study is to confirm the superiority of preCRT followed by surgery plus adjuvant chemotherapy over surgery plus adjuvant chemotherapy alone, in terms of local relapse-free survival for resectable LRRC. Methods: Eligibility criteria include resectable LRRC without distant metastasis, no prior pelvic irradiation, no prior surgery for LRRC, aged 20-80 years, and sufficient organ function. Eligible patients are randomized into the surgery and adjuvant chemotherapy (arm A) or preCRT followed by surgery and adjuvant chemotherapy (arm B). PreCRT consists of the standard dose of capecitabine and radiotherapy (50.4Gy). Adjuvant chemotherapy consists of mFOLFOX6, CAPOX, capecitabine, or 5FU+l-LV. The primary endpoint is local relapse-free survival (LRFS), and the secondary endpoints include overall survival, relapse-free survival, %R0 resection, incidence of adverse events, and quality of life after surgery. The 3-year LRFS of arm A is assumed to be 60% with a 13% increase expected in arm B. The sample size was calculated as 106 (53 per arm) with a one-sided alpha of 10%, power of 70%, and accrual period of 6 years. This trial was initiated on 19 August 2019. Clinical trial information: jRCTs031190076.

scholarly journals 455 Proton Beam Therapy in Rectal Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Fok ◽  
S Toh ◽  
J E Maducolil ◽  
H Fowler ◽  
R Clifford ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Proton Beam ◽  
Organs At Risk ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Significant Risk ◽  
Proton Beam Therapy ◽  
Recurrent Rectal Cancer ◽  
Pelvic Bone ◽  
Dosimetric Data

Abstract Introduction Radiotherapy for locally advanced rectal cancer is conventionally performed using photon-based radiotherapy (PBR), carrying significant risk of toxicity to organs at risk (OAR). Proton beam therapy (PBT) potentially delivers equivalent dosimetric radiation to the targeted tissue with improved sparing of OAR. We aimed to compare dosimetric irradiation of OAR for PBT versus PBR in patients with rectal cancer and assess any oncological outcomes. Method An extensive electronic literature search was performed from inception till April 2020 and subsequent meta-analysis performed. Results Six articles met the inclusion criteria. Dosimetric data of irradiation delivered to OAR for PBT and PBR were calculated for the same patients. PBT had significantly less irradiated small bowel compared to 3DCRT and IMRT, (MD -16.95, 95% CI [-24.03, -9.88], p < 0.00001) and (MD -6.96, 95% CI [-12.99, -0.94], p = 0.02) respectively. Similar results were observed for bladder and pelvic bone marrow. Two studies reported clinical and oncological results for PBT in recurrent rectal cancer with overall survival reported as 43% and 68%. Conclusions Dosimetric treatment plans have less irradiation of OAR for rectal cancer with PBT compared to PBR. There is a need for further research in PBT and rectal cancer, as promising results have been shown in recurrent rectal cancer.

scholarly journals Intraoperative Electron Radiation Therapy (IOERT) in the management of locally recurrent rectal cancer

BMC Cancer ◽  
2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Falk Roeder ◽  
Joerg-Michael Goetz ◽  
Gregor Habl ◽  
Marc Bischof ◽  
Robert Krempien ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Recurrent Rectal Cancer ◽  
Electron Radiation ◽  
Locally Recurrent Rectal Cancer ◽  
Locally Recurrent

Usefulness of carcinoembryonic antigen doubling time in prognosis prediction after curative resection of locally recurrent rectal cancer: A retrospective study

2021 ◽  
Author(s):  
JUNICHI SAKAMOTO ◽  
Heita Ozawa ◽  
Hiroki Nakanishi ◽  
Shin Fujita
Keyword(s):  
Rectal Cancer ◽  
Carcinoembryonic Antigen ◽  
Curative Resection ◽  
Doubling Time ◽  
Multivariate Analyses ◽  
Recurrent Rectal Cancer ◽  
Oncologic Outcomes ◽  
Prognosis Prediction ◽  
Locally Recurrent Rectal Cancer ◽  
Locally Recurrent

Introduction: Given that doubling time is an indicator of tumor growth, we assessed the usefulness of carcinoembryonic antigen doubling time (CEA-DT) in prognosis prediction after curative resection for locally recurrent rectal cancer. Methods: During January 1986 to December 2016, 33 patients with locally recurrent rectal cancer who underwent curative resection at our hospital were retrospectively reviewed. The primary endpoint was the 3-year recurrence-free survival (RFS) rate. The Kaplan-Meier method was used to compare RFS rates and evaluate univariate and multivariate analyses for factors associated with oncologic outcomes, including CEA-DT. CEA-DT was classified into two groups: the short and long CEA-DT groups. Results: The 3-year overall survival and RFS rates were 62.6% and 42.4%, respectively. In multivariate analyses, CEA-DT was an independent risk factor for poor RFS. The 3-year RFS rate was significantly better in the long CEA-DT group than in the short CEA-DT group (58.8% vs. 25.0%, p = 0.0063). Conclusion: CEA-DT is a useful prognostic factor that can be assessed before surgery for locally recurrent rectal cancer. Long CEA-DT may indicate a favorable prognosis. Contrarily, short CEA-DT is associated with poor prognosis; therefore, further treatment intervention is necessary for patients with short CEA-DT.

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