Hyperfractionated accelerated reirradiation for rectal cancer: An analysis of outcomes and toxicity
Hyperfractionated accelerated reirradiation for rectal cancer: An analysis of outcomes and toxicity
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DOI：
10.1016/j.radonc.2016.12.015
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发表时间：
2017-01-01
影响因子：
5.7
通讯作者：
Das, Prajnan
中科院分区：
文献类型：
--
作者：
Tao, Randa;Tsai, Chiaojung Jillian;Das, Prajnan
背景和目的：评估接受超分割盆腔再照射治疗复发性直肠癌患者的结局和毒性。材料和方法：102例复发直肠腺癌采用加速盆腔超分割照射，每次1.5戈伊，每日2次，总剂量30-45戈伊（中位数39戈伊），最常见的总剂量为39戈伊（n = 90，88%）。中位盆腔放疗剂量为25-63戈伊（50.4.戈伊）。3年无局部进展（FFLP）率为40%，3年总生存率（OS）为39%。手术治疗与FFLP和OS改善显著相关，与未手术治疗相比，3年FFLP率为49% vs. 30%（P = 0.013），3年OS率为62% vs. 20%（P < 0.0001）。3-4级晚期毒性的精算3年率为3 - 4%;与未手术的患者相比，接受手术的患者3-4级晚期毒性的发生率显著较高（54% vs. 16%，P = 0.001）。结论：这项大型回顾性单机构研究表明，超分割加速再照射耐受性良好。考虑到该研究包括接受过大量预治疗的复发患者，FFLP的发生率是有希望的。接受再照射和手术的患者的FFLP和OS率尤其令人印象深刻。出版社：Elsevier爱尔兰Ltd.
Background and purpose: To evaluate outcomes and toxicity in patients treated with hyperfractionated pelvic reirradiation for recurrent rectal cancer.Materials and methods: 102 patients with recurrent rectal adenocarcinoma were treated with pelvic reirradiation with a hyperfractionated accelerated approach, consisting of 1.5 Gy twice daily fractions to a total dose Of 30-45 Gy (median 39 Gy), with the most common total dose 39 Gy (n = 90, 88%). The median dose of prior pelvic radiation therapy (RT) was 50.4.Gy (range: 25-63 Gy).Results: The median follow-up was 40 months for living patients (range, 3-150 months). The 3-year freedom from local progression (FFLP) rate was 40% and the 3-year overall survival (OS) rate was 39%. Treatment with surgery was significantly associated with improved FFLP and OS, with 3-year FFLP rate of 49% vs. 30% (P = 0.013), and 3-year OS rate of 62% vs. 20% (P < 0.0001), compared to those without surgery. The actuarial 3-year rate of grade 3-4 late toxicity was 34%; patients who underwent surgery had a significantly higher rate of grade 3-4 late toxicity compared to those without surgery (54% vs. 16%, P = 0.001).Conclusions: This large, retrospective, single-institution study shows that hyperfractionated accelerated reirradiation was well tolerated. The rate of FFLP was promising, given that the study comprised heavily pre-treated patients with recurrences. Rates of FFLP and OS were particularly impressive in patients who underwent both reirradiation and surgery. Published by Elsevier Ireland Ltd.