Carbon-ion radiotherapy for pelvic recurrence of rectal cancer
Mené sur 180 patients atteints d'un cancer rectal ayant récidivé au niveau de la région pelvienne, cet essai de phase I/II évalue l'efficacité, du point de vue du contrôle local et des taux de survie à 5 ans, et la toxicité d'une radiothérapie par ions carbone
Purpose : Investigation of the treatment potential of carbon-ion radiotherapy in pelvic recurrence of rectal cancer. Patients and Methods : A phase I/II dose escalation study was performed. 180 patients (186 lesions) with locally-recurrent rectal cancer were treated with carbon-ion radiotherapy (CIRT) (Phase I/II: 37 and 143 patients, respectively). Relapse locations: 71 presacral region, 82 pelvic sidewalls, 28 perineum, 5 near colorectal anastomosis. A 16 fraction in 4 week dose regimen was used, with total dose ranging from 67.2 to 73.6 Gy (RBE) ; RBE-weighted absorbed dose (4.2-4.6 Gy (RBE)/fraction). Results : During phase I, the highest total dose, 73.6 Gy (RBE), resulted in no grade 3+ acute reactions in the 13 so-treated patients. Dose escalation was halted at this level, and this dose was used for phase II, with no other grade 3+ acute reactions observed. At five years, the local control and survival rates at 73.6 Gy (RBE) were 88% (95% CI, 80% to 93%) and 59% (95% CI, 50% to 68%), respectively. Conclusion : Carbon-ion radiotherapy may be a safe, effective treatment option for locally-recurrent rectal cancer, and may serve as an alternative to surgery.
http://www.redjournal.org/article/S0360-3016%2816%2930133-X/abstract 2016