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Abstract
OBJECTIVE:
To evaluate outcomes and toxicity profiles after re-irradiation in patients with pelvic recurrence of anorectal cancer.

METHODS:
25 anorectal cancer patients who received re-irradiation for pelvic recurrence between 2005 and 2015 were included. For initial treatment, all patients underwent surgical resection and preoperative or postoperative radiotherapy.

RESULTS:
The median follow-up duration was 21.5 months (range, 2.9-84.4). After a median of 43.3 months (range, 11.7-218.5), patients received re-irradiation with a median dose of 45 Gy (range, 36-60). The equivalent dose in 2 Gy fractions (EQD2) of re-irradiation-calculated using α/β = 10 Gy-ranged from 34.5 to 84.0 Gy (median, 46.4). Surgical resection was performed for 11 patients, and 14 patients received concurrent chemotherapy with re-irradiation. The 3-year local progression-free survival was 29.7%. The 3-year overall survival was 49.7%. Concurrent chemotherapy with re-irradiation and re-irradiation doses >50 Gy EQD2α/β=10 were significant prognostic factors for local progression free survival and overall survival according to multivariate analysis. 90% (9 of 10) of patients with symptoms had improvement after re-irradiation. Among 23 patients available for evaluation of late toxicity, 12 developed late toxicities. There were no Grade 4 late toxicities, and 6 patients had Grade 3 late toxicities (small bowel obstruction, bowel perforation and fistula).

CONCLUSION:
Re-irradiation for pelvic recurrence of anorectal cancer improved symptoms of patients but the rate of late toxicity was high. Further investigation for patient selection is required.

ADVANCES IN KNOWLEDGE:
Re-irradiation could be considered as a possible option for pelvic recurrence of anorectal cancer in selected patients.

Author information

Park Y1, Kim K2, Park HJ3, Jeong SY4, Park KJ4, Han SW5, Kim TY5, Chie EK6.
1
1 Department of Radiation Oncology, Soonchunhyang University Seoul Hospital , Seoul , Republic of Korea.
2
2 Department of Radiation Oncology, Ewha Womans University College of Medicine , Republic of Korea.
3
3 Department of Radiation Oncology, Hanyang University College of Medicine , Seoul, Republic of Korea.
4
4 Department of Surgery, Seoul National University College of Medicine , Seoul , Republic of Korea.
5
5 Department of Internal Medicine, Seoul National University College of Medicine , Seoul , Republic of Korea.
6
6 Department of Radiation Oncology, Seoul National University College of Medicine , Seoul , Republic of Korea.