Background:
The current study was conducted to assess the long-term results of reirradiation in patients with recurrent rectal carcinoma.
Methods:
One hundred and three patients with recurrent adenocarcinoma of the rectum underwent reirradiation with concurrent 5-fluorouracil-based chemotherapy. the initial radiation dose to the pelvis ranged from 3000 to 7400 centigrays (cgy) with a median dose of 5040 cgy. the median time from initial treatment to recurrence was 19 months. irradiation techniques consisted of two lateral fields with/without a posterior pelvic field to include recurrent tumor with a margin of 2-4 cm only. the reirradiation doses ranged from 1500 to 4920 cgy with a median dose of 3480 cgy. total cumulative doses ranged from 7060 to 1080 cgy with a median total dose of 8580 cgy. after the reirradiation, 34 patients also underwent surgical resection for residual disease. fourteen patients underwent pelvic exenteration, 11 patients underwent abdominoperineal resection, 4 patients underwent transanal transabdominal proctosigmoidectomy, 2 patients underwent full thickness local excision, and 3 patients underwent a hartmann resection.
Results:
Follow-up ranged from 3 84 months with a median follow-up of 2 years. the median survival for the whole group was 26 months and the 5-year actuarial survival rate was 19%. the median interval and 5-year survival rate of patients undergoing surgical resection after reirradiation was 44 months and 22% compared with 14 months and 15% for patients treated with reirradiation only (p = 0.001). treatment was generally well tolerated. fifteen patients required a treatment break and early termination of treatment for grade 3 and higher diarrhea, moist desquamation, or mucositis. late complications were seen in 22 patients, including persistent severe diarrhea in 18 patients with 10 patients requiring long-term parental support, small bowel obstruction was seen in 15 patients, fistula formation in 4 patients, and coloanal stricture in 2 patients. there was no difference in incidence of acute or long-term complications by the total radiation dose delivered.
Conclusions:
In patients with recurrent rectal carcinoma, high doses of reirradiation can be delivered with acceptable risks without prohibitive long-term side effects. surgical salvage and long-term survival of patients are possible.