Stereotactic Body Radiotherapy re-irradiation for locally recurrent rectal cancer: outcomes and toxicity

Smith, T., O'Cathail, S. M. , Silverman, S., Robinson, M., Tsang, Y., Harrison, M. and Hawkins, M. A. (2020) Stereotactic Body Radiotherapy re-irradiation for locally recurrent rectal cancer: outcomes and toxicity. Advances in Radiation Oncology, 5(6), pp. 1311-1319. (doi: 10.1016/j.adro.2020.07.017) (PMID:33305093) (PMCID:PMC7718547)

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Background: Stereotactic body radiotherapy (SBRT) has emerged as a potential therapeutic option for locally recurrent rectal cancer (LRRC) but contemporaneous clinical data is limited. We aimed to evaluate the local control, toxicity and survival outcomes in a cohort of patients previously treated with neoadjuvant pelvic radiotherapy for non-metastatic LRRC, now treated with SBRT. Methods: Inoperable rectal cancer patients with ≤ 3 sites of pelvic recurrence and > 6 months since prior pelvic radiotherapy were identified from a prospective registry over 4 years. SBRT dose was 30Gy in 5 fractions, daily or alternate days, using cumulative organ at risk dose constraints. Primary outcome was local control (LC). Secondary outcomes were progression free survival (PFS), overall survival (OS), toxicity and patient reported Quality of Life scores (QoL) using EQ-VAS tool. Results: 30 patients (35 targets) were included. Median GTV size was 14.3cm3. 27/30 (90%) previously received 45-50.4Gy in 25/28 fractions, with 10% receiving an alternative prescription. All patients received the planned re-irradiation SBRT dose. The median FU was 24.5 months (IQR 17.8 – 28.8). The 1-year LC was 84.9% (95% CI 70.6 – 99) and a 2-year LC was 69% (95% CI 51.8 – 91.9). The median PFS was 12.1 months (95% 8.6 – 17.66) and median OS was 28.3 months (95% CI 17.88 – 39.5 months). No patient experienced >G2 acute toxicity and only 1 patient experienced late G3 toxicity. Patient reported QoL outcomes were improved at 3 months following SBRT (Δ EQ-VAS, +10 points, Wilcoxon signed rank, p=0.009). Conclusion: Our study demonstrates that, for small volume pelvic disease relapses from rectal cancer, re-irradiation with 30Gy in 5 fractions is well tolerated and achieves an excellent balance between high local control rates with limited toxicity.

Item Type:Articles
Glasgow Author(s) Enlighten ID:O'Cathail, Dr Sean
Authors: Smith, T., O'Cathail, S. M., Silverman, S., Robinson, M., Tsang, Y., Harrison, M., and Hawkins, M. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Journal Name:Advances in Radiation Oncology
Publisher:Elsevier Inc. on behalf of American Society for Radiation Oncology
ISSN (Online):2452-1094
Published Online:07 August 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Advances in Radiation Oncology 5(6):1311-1319
Publisher Policy:Reproduced under a Creative Commons licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
174115CRUK Centre RenewalOwen SansomCancer Research UK (CRUK)C7932/A25142CS - Beatson Institute for Cancer Research