Radiol Med (Torino) 1991 Dec;82(6):833-8

Salvage radiotherapy in postoperative recurrences of rectal and rectosigmoid carcinomas

Gardani G, Valvo F, Lozza L, Tana S, Zucali R

Istituto di Scienze Radiologiche, Universita, Milano.

One hundred and twenty-five patients, previously operated for rectal or rectosigmoid cancer, have been submitted to external radiation therapy from 1964 to 1985 on pelvic and/or perineal recurrence (50 perineal, 66 pelvic, 9 both). Fifty-seven per cent received more than 50 Gy, but only 14% more than 60 Gy. Overall survival has been poor (66% at 1 year, 20% at 3 years, 15% at 5 years) whereas better results have been achieved for pain relief: complete remission in 49% and partial remission in 26% of 77 symptomatic patients. Among 94 patients, evaluable for tumor size before and after treatment, radiation significantly decreased the size of the recurrence in 63% (27% CR). Among prognostic factors (recurrence site, radiation dose, age, pain relief and disease-free interval since surgery) only perineal recurrence without pelvic involvement, if treated with high doses (greater than 50 Gy), seems to be related to a significantly improved prognosis.

Int J Radiat Oncol Biol Phys 1999 Feb 1;43(3):531-6

Results of external beam radiotherapy alone for incompletely resected carcinoma of rectosigmoid or rectum: Peter MacCallum Cancer Institute experience 1981-1990.

Guiney MJ, Smith JG, Worotniuk V, Ngan S

Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.

A retrospective review was carried out of all patients (57) presenting to Peter MacCallum Cancer Institute from 1981 to 1990 with incompletely resected nonmetastatic rectosigmoid or rectal cancer who were treated with external beam radiotherapy. Three radiotherapy schedules were used: radical (50 to 60 Gy, 27 patients), high-dose palliative (45 Gy, 25 patients), and low-dose palliative (less than 45 Gy, 5 patients). Symptomatic response, overall survival, and the effect of prognostic factors on treatment outcome were evaluated. The median follow-up period for survivors was 49 months. RESULTS: Symptomatic response rates were 83% and 79% for the radical and high-dose palliative groups respectively. The estimated median survival time from presentation for all patients was 16.4 months (radical 26.1 months, high-dose palliative 15.7 months). Patients with microscopic residual disease survived significantly longer than patients with macroscopic residual disease (estimated median survival time 30.7 months vs. 14.3 months, p = 0.013). CONCLUSIONS: No dose response effect was seen between the radical group and high-dose palliative group. Microscopic residual disease at presentation was the only significant predictor of better survival. The conventionally fractionated course of 50 to 60 Gy was not significantly better in terms of palliation and overall survival than a shorter palliative course of 45 Gy. In future, preoperative chemoradiation should improve outcome by reducing the number of patients with incompletely resected cancer.

Int J Radiat Oncol Biol Phys 1997 Jul 15;38(5):1019-25

Radiotherapy treatment for isolated loco-regional recurrence of rectosigmoid cancer following definitive surgery: Peter MacCallum Cancer Institute experience, 1981-1990.

Guiney MJ, Smith JG, Worotniuk V, Ngan S, Blakey D

Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.

PA retrospective analysis of 135 patients with locally recurrent rectosigmoid cancer presenting to Peter MacCallum Cancer Institute between January 1981 and December 1990 was undertaken. Patients were treated with three different dose ranges of radiotherapy: 50-60 Gy ("Radical" group), 45 Gy ("High-dose palliative" group), and <45 Gy ("Low-dose palliative" group). Symptomatic response rates and overall survival for each group were determined. RESULTS: Symptomatic response rates of 85, 81, and 56% were achieved in the radical, high-dose palliative, and low-dose palliative groups, respectively. Estimated median survival times were 17.9, 14.8, and 9.1 months for the radical, high-dose palliative, and low-dose palliative groups, respectively.

Radiother Oncol 1995 Mar;34(3):185-94

Treatment of local recurrences of rectal carcinoma.

Frykholm GJ, Pahlman L, Glimelius B

Department of Oncology, Akademiska sjukhuset, Uppsala University, Sweden.

From 1978-1992, 159 patients were treated for local recurrences of rectal carcinoma. They could be subdivided into three groups according to the type of primary treatment given; 82 patients underwent primary surgery without irradiation, 37 patients had preoperative and 40 patients postoperative radiotherapy. The localizations of the recurrences and the curative and palliative potentials of surgery and radiotherapy in the treatment of local recurrences were studied. There was no difference in the localisation of the recurrences in the three groups. Median time between initial surgery and recurrence was also almost the same in the three groups and 75% of the recurrences appeared within 2 years. Twenty percent of the patients in the primary surgery alone group, compared with 49% and 38% in the preoperative and postoperative irradiation groups, respectively, had distant metastases at the time of the diagnosis of local recurrence. The predominant symptom from the local recurrence was pain and, after treatment of the recurrence, pain relief was registered in 63%. In 66%, 16% and 22%, respectively, of the patients in the three groups, the intention of the treatment was curative, with either radiotherapy alone, radiotherapy combined with surgery or surgery alone. The 5-years-survival after recurrence was 6% in the primary surgery alone group and 0% in the other 2 groups. Of the 69 patients treated with a curative intention, 32% were locally symptom-free at death or the last follow-up. Our conclusion is that a local recurrence must be avoided due to the morbidity associated with local failure and the potentially low likelihood of curative treatment of a local recurrence.

Int J Radiat Oncol Biol Phys 1997 Jul 1;38(4):785-90

Palliative reirradiation for recurrent rectal cancer.

Lingareddy V, Ahmad NR, Mohiuddin M

Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Fifty-two patients with recurrent rectal adenocarcinoma following previous pelvic RT underwent reirradiation. Median initial RT dose to the pelvis was 50.4 Gy. Median reirradiation dose was 30.6 Gy. Twenty-two patients received 1.2 Gy b.i.d., and 30 patients received 1.8-2.0 Gy daily. Total cumulative doses ranged from 66.6 to 104.9 Gy (median: 84.4 Gy). Forty-seven patients (90%) received concurrent 5-FU chemotherapy. Forty-four patients were followed until death, and the median follow-up time was 16 months. RESULTS: The RTOG Grade 3 acute toxicity rate was 31%. The RTOG Grade 3 and 4 late toxicity rates were 23 and 10%, respectively. On multivariate analysis, the only factor associated with reduced late toxicity was hyperfractionated delivery of reirradiation. Bleeding, pain, and mass effect were palliated completely in 100, 65, and 24% of instances, respectively, and the majority of responding patients were palliated until death. The overall median survival time from retreatment was 12 months. The 2- and 3-year overall actuarial survival rates were 25 and 14%, respectively. CONCLUSION: This unique institutional approach to recurrent rectal cancers resulted in excellent palliation of symptoms. Late complications appeared reduced by hyperfractionated treatment delivery.

Ann Chir Gynaecol 1977;66(6):265-8

Inoperable and recurrent carcinoma of the rectum and rectosigmoid. Aspects of radiation treatment and prognosis.

Nordman E, Gronroos M, Aho AJ, Numminen S

35 patients treated with radiotherapy for recurrent (23) or primarily inoperable (12) rectal or rectosigmoid carcinoma are presented. The radiation treatment was delivered in 28 cases with megavoltage equipment, in two cases with a conventional X-ray unit and in seven cases with intracavitary radium or cathetron applications. 17 of the patients (49%) lived for more than one year. Six patients from the recurrent cases lived (26%) for more than two years, and four patients (17%) survived three years. Relief of symptoms was observed in at least 20 cases. The importance of early diagnosis of recurrent tumor is stressed especially in the follow-up of Dukes' A and B groups.

Cancer Radiother 1999 Jan-Feb;3(1):39-50

Locoregional recurrence of adenocarcinomas of the rectum treated with irradiation combined with or without excision surgery.

Touboul E, Buffat L, Minne JF, Ganansia V, Mitry E, Balosso J, Breteau N, Gallot D, Parc R, Schlienger M, Laugier A, Housset M

Service d'oncologie-radiotherapie, hopital Tenon, Paris, France.

Between March 1973 and November 1991, 211 patients with loco-regional recurrence of rectum cancer were treated with external beam radiation treatment. Radical surgery was the only initial treatment modality. Surgical resection of local recurrence was done in 36 patients and only 17 patients could undergo complete resection. Forty-seven patients underwent radiotherapy (RT) combined with surgery and 164 received external beam radiation treatment alone to a mean total dose of 46 Gy. RESULTS: Among the 151 patients whose recurrence was revealed by pain, 64 (42%) were considered to have a complete symptomatic response after loco-regional treatment with radiosurgery or RT alone. The mean duration of response was 12 months. The 3-year overall survival rate was 16%. Five prognostic factors decreased the overall survival rate in multivariate analysis: high age, sex (male), concomitant distant metastasis, no tumor resection, and low total radiation dose with external beam radiation treatment alone. The 3-year overall survival rate for patients with completely resected recurrences was 39%. CONCLUSION: External beam RT treatment can only be considered a palliative symptomatic treatment. New techniques of early detection of local recurrence and new combined modalities approaches (radiation sensitizers or intra-operative radiotherapy) with surgical resection in some favorable cases should be studied.

Acta Radiol Oncol 1982;21(2):105-9

Radiation therapy of recurrences of carcinoma of the rectum and sigmoid after surgery.

Ciatto S, Pacini P

Loco-regional recurrences are the most common type of postsurgical relapse of rectal and sigmoid carcinoma. The authors report on 108 consecutively treated patients: site, clinical features and symptoms of the recurrences are considered together with treatment results. A symptomatic effect was generally achieved with 35 to 45 Gy, while higher doses did not improve the response. Due to the high frequency of simultaneous involvement of perineum and true pelvis the authors recommend irradiation of both regions. Palliation is the sole aim in most cases. However, curative treatment can be attempted in single perineal recurrences.