Smith Thomas, O'Cathail Sean M, Silverman Sabrina, Robinson Maxwell, Tsang Yatman, Harrison Mark, Hawkins Maria A
Mount Vernon Cancer Centre, East and North Herefordshire NHS Trust, Middlesex, UK.
Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
Adv Radiat Oncol. 2020 Aug 7;5(6):1311-1319. doi: 10.1016/j.adro.2020.07.017. eCollection 2020 Nov-Dec.
Stereotactic body radiation therapy (SBRT) has emerged as a potential therapeutic option for locally recurrent rectal cancer (LRRC) but contemporaneous clinical data are limited. We aimed to evaluate the local control, toxicity, and survival outcomes in a cohort of patients previously treated with neoadjuvant pelvic radiation therapy for nonmetastatic locally recurrent rectal cancer, now treated with SBRT.
Inoperable rectal cancer patients with ≤3 sites of pelvic recurrence and >6 months since prior pelvic radiation therapy were identified from a prospective registry over 4 years. SBRT dose was 30 Gy 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, overall survival, toxicity, and patient reported quality of life scores using the EQ visual analog scale (EQ-VAS) tool.
Thirty patients (35 targets) were included. Median gross tumor volume size was 14.3 cm. In addition, 27 of 30 (90%) previously received 45 to 50.4 Gy in 25 of 28 fractions, with 10% receiving an alternative prescription. All patients received the planned reirradiation SBRT dose. The median follow-up was 24.5 months (interquartile range, 17.8-28.8). The 1-year LC was 84.9% (95% confidence interval [CI], 70.6-99) and a 2-year LC was 69% (95% CI, 51.8-91.9). The median progression free survival was 12.1 months (95% CI, 8.6-17.66), and median overall survival 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 after SBRT (Δ EQ-VAS, +10 points, Wilcoxon signed-rank, = .009).
Our study demonstrates that, for small volume pelvic disease relapses from rectal cancer, reirradiation with 30 Gy in 5 fractions is well tolerated and achieves an excellent balance between high local control rates with limited toxicity.
立体定向体部放射治疗（SBRT）已成为局部复发性直肠癌（LRRC）的一种潜在治疗选择，但同期临床数据有限。我们旨在评估一组先前接受新辅助盆腔放疗的非转移性局部复发性直肠癌患者，现接受SBRT治疗后的局部控制、毒性和生存结果。
从一个前瞻性登记处筛选出4年内不可手术的直肠癌患者，这些患者盆腔复发部位≤3个，且距先前盆腔放疗已超过6个月。SBRT剂量为30 Gy，分5次，每天或隔天进行，采用累积危及器官剂量限制。主要结局是局部控制（LC）。次要结局是无进展生存期、总生存期、毒性，以及使用EQ视觉模拟量表（EQ-VAS）工具的患者报告的生活质量评分。
纳入30例患者（35个靶区）。肿瘤总体积中位数大小为14.3 cm。此外，30例患者中有27例（90%）先前接受了28次分割中的25次、45至50.4 Gy的放疗，10%接受了替代处方。所有患者均接受了计划的再程放疗SBRT剂量。中位随访时间为24.5个月（四分位间距，17.8 - 28.8）。1年局部控制率为84.9%（95%置信区间[CI]，70.6 - 99），2年局部控制率为69%（95% CI，51.8 - 91.9）。中位无进展生存期为12.1个月（95% CI，8.6 - 17.66），中位总生存期为28.3个月（95% CI，17.88 - 39.5个月）。没有患者出现>2级急性毒性，只有1例患者出现晚期3级毒性。患者报告的生活质量结局在SBRT后3个月有所改善（EQ-VAS变化，+10分，Wilcoxon符号秩检验，P = 0.009）。
我们的研究表明，对于直肠癌盆腔小体积疾病复发，5次分割给予30 Gy的再程放疗耐受性良好，在高局部控制率和有限毒性之间实现了良好平衡。
Zotero 插件
