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. 2016 Feb 15;8(2):1265-72.
eCollection 2016.

Intensity-modulated radiation therapy for pelvic oligo-recurrence from rectal cancer: long-term results from a single institution

Xiang-Gao Zhu  1 , Yong-Heng Li  2 , Xiao-Fan Li  2 , Yong Cai  2
Affiliations

Intensity-modulated radiation therapy for pelvic oligo-recurrence from rectal cancer: long-term results from a single institution

Xiang-Gao Zhu et al. Am J Transl Res. .

Abstract

Background: Pelvic oligo-recurrence is common in rectal cancer patients, and some could not achieve radical resection.

Objective: The study was to analyze long-term outcomes and prognostic factors associated with survival in patients treated with intensity-modulated radiation therapy (IMRT).

Methods: Study participants were identified from rectal patients with pelvic oligo-recurrence without distant metastases, who were not suitable for surgery (n=135). Patients were recommended to receive concurrent chemotherapy in the course of IMRT (median dose 64.5 Gy, range: 45-70 Gy). Additionally, 24.4% (33/135) of patients received radical surgery after preoperative radiotherapy. Median time to pelvic failure was 25.4 months (range: 1-144 months). With a median follow-up period of 45.5 months (range: 3-104 months), 5-year overall survival (OS) and disease-free survival (DFS) were 55.6% and 45.5%, respectively.

Results: In univariate survival analysis, OS stratified by subsites indicated that 5-year OS for anastomotic recurrence (80.5%) was better than for anterior recurrence (57.7%) and other pelvic oligo-recurrences (44.5%) (P=0.005). Five-year DFS in the three groups was 60.3%, 49% and 36.6%, respectively (P=0.037). In multivariate survival analysis, pelvic oligo-recurrence and symptomatic recurrence patterns were independently associated with OS in recurrent rectal cancer after pelvic radiotherapy (RT).

Conclusions: These results indicate that RT for rectal cancer patients with pelvic oligo-recurrence had favorable prognosis, especially for patients with anastomotic recurrence.

Keywords: Rectal cancer; intensity-modulated radiation therapy; pelvic oligo-recurrence.

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Figures

Figure 1
Figure 1
Transverse computed tomographic slices of the different recurrence pelvic subsites and treatment regions. Yellow arrow: GTV; Red arrow: CTV. A. Pre-sacral recurrence. B. Genitourinary recurrence. C. Anastomatic recurrence. D. Perineal recurrence. E. Lateral recurrence. F. Lymph nodes along the internal iliac vessels. G. Lymph nodes along the external iliac vessels. H. Superficial inguinal lymph nodes.
Figure 2
Figure 2
Kaplan-Meier curves of overall survival (A) and disease-free survival (B) in rectal cancer patients with pelvic oligo-recurrence after radiotherapy.
Figure 3
Figure 3
Kaplan-Meier curves of overall survival (A) and disease-free survival (B) in three groups classified as different subsites of pelvic oligo-recurrence. Others: Pre-sacral, lateral, perineal and internal iliac lymph nodes recurrences; Anastomosis: recurrences in anastomosis; Anterior: recurrences in anterior of rectum including bladder, vagina, uterus, seminal vesicles and prostate.
See this image and copyright information in PMC

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