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Characterization of efficacy and toxicity after high-dose pelvic reirradiation with palliative intent for genitourinary second malignant neoplasms or local recurrences after full-dose radiation therapy in the pelvis: A high-volume cancer center experience.

Abstract The use of large-field external beam reirradiation (re-RT) after pelvic radiation therapy (RT) for genitourinary (GU) cancers has not been reported. We report the results of such treatment in patients with either symptomatic GU second malignant neoplasms or locally recurrent pelvic tumors after initial RT for whom surgery or further systemic therapy was not an option.
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Authors

Mayor MeshTerms
Keywords
Journal Title advances in radiation oncology
Publication Year Start




PMID- 28740925
OWN - NLM
STAT- PubMed-not-MEDLINE
DA  - 20170725
LR  - 20170728
IS  - 2452-1094 (Print)
IS  - 2452-1094 (Linking)
VI  - 2
IP  - 2
DP  - 2017 Apr-Jun
TI  - Characterization of efficacy and toxicity after high-dose pelvic reirradiation
      with palliative intent for genitourinary second malignant neoplasms or local
      recurrences after full-dose radiation therapy in the pelvis: A high-volume cancer
      center experience.
PG  - 140-147
LID - 10.1016/j.adro.2017.01.001 [doi]
AB  - PURPOSE: The use of large-field external beam reirradiation (re-RT) after pelvic 
      radiation therapy (RT) for genitourinary (GU) cancers has not been reported. We
      report the results of such treatment in patients with either symptomatic GU
      second malignant neoplasms or locally recurrent pelvic tumors after initial RT
      for whom surgery or further systemic therapy was not an option. METHODS AND
      MATERIALS: The records of 28 consecutive patients with advanced, bulky GU
      malignancies treated with high-dose, large-field re-RT with palliative intent
      between 2008 and 2014 were retrospectively reviewed. Descriptive outcome analyses
      focused on toxicities and symptom control, and responses were evaluated by 2
      independent observers. RESULTS: Twenty-seven male patients (96%) were included.
      Median initial external beam RT dose was 64 Gy (range, 30-75.6 Gy). The median
      time between initial RT and re-RT was 9.5 years (range, 0.2-32 years). At the
      time of re-RT, there were 16 local recurrences and 12 second malignant neoplasms 
      together comprising 16 bladder, 10 prostate, 1 ureteral, and 1 penile cancer.
      Indications for re-RT were pain and bleeding/hemorrhage. The median equivalent
      sphere diameter planning target volume for re-RT was 8.6 cm (range, 4.7-16.3 cm).
      Given the severity of the symptoms and the bulk of the disease at the time of
      re-RT, a higher dose of RT was administered. The median re-RT dose was 50 Gy
      (range, 27.5-66 Gy). For patients who received <60 Gy, hypofractionation of 250
      cGy was used. The median cumulative dose was 113.9 Gy (range, 81.5-132.8 Gy).
      Re-RT was well tolerated with no Radiation Therapy Oncology Group grade 3-4
      toxicities. Twenty-four patients (92%) had complete resolution of symptoms, and
      relief was durable in 67% of patients. The median overall survival was 5.8 months
      (range, 0.3-38.9 months). Of those patients who are still alive, 100% remain free
      of initial symptoms. CONCLUSION: This small series suggests that aggressive re-RT
      of inoperable and symptomatic GU malignancies that is undertaken with meticulous 
      treatment planning is well tolerated and provides excellent, durable relief
      without undue short-term toxicity. Validation in a larger prospective cohort is
      required.
FAU - Kamran, Sophia C
AU  - Kamran SC
AD  - Harvard Radiation Oncology Program, Boston, Massachusetts.
FAU - Harshman, Lauren C
AU  - Harshman LC
AD  - Dana-Farber Cancer Institute, Department of Medical Oncology, Boston,
      Massachusetts.
FAU - Bhagwat, Mandar S
AU  - Bhagwat MS
AD  - Brigham and Women's Hospital, Department of Radiation Oncology, Boston,
      Massachusetts.
FAU - Muralidhar, Vinayak
AU  - Muralidhar V
AD  - Harvard Medical School, Boston, Massachusetts.
FAU - Nguyen, Paul L
AU  - Nguyen PL
AD  - Dana-Farber Cancer Institute, Department of Medical Oncology, Boston,
      Massachusetts.
AD  - Brigham and Women's Hospital, Department of Radiation Oncology, Boston,
      Massachusetts.
FAU - Martin, Neil E
AU  - Martin NE
AD  - Dana-Farber Cancer Institute, Department of Medical Oncology, Boston,
      Massachusetts.
AD  - Brigham and Women's Hospital, Department of Radiation Oncology, Boston,
      Massachusetts.
FAU - La Follette, Stephanie
AU  - La Follette S
AD  - Brigham and Women's Hospital, Department of Radiation Oncology, Boston,
      Massachusetts.
FAU - Faso, Sarah
AU  - Faso S
AD  - Brigham and Women's Hospital, Department of Radiation Oncology, Boston,
      Massachusetts.
FAU - Viswanathan, Akila N
AU  - Viswanathan AN
AD  - Dana-Farber Cancer Institute, Department of Medical Oncology, Boston,
      Massachusetts.
AD  - Brigham and Women's Hospital, Department of Radiation Oncology, Boston,
      Massachusetts.
FAU - Efstathiou, Jason A
AU  - Efstathiou JA
AD  - Department of Radiation Oncology, Massachusetts General Hospital, Boston,
      Massachusetts.
FAU - Beard, Clair J
AU  - Beard CJ
AD  - Dana-Farber Cancer Institute, Department of Medical Oncology, Boston,
      Massachusetts.
AD  - Brigham and Women's Hospital, Department of Radiation Oncology, Boston,
      Massachusetts.
LA  - eng
PT  - Journal Article
DEP - 20170117
PL  - United States
TA  - Adv Radiat Oncol
JT  - Advances in radiation oncology
JID - 101677247
PMC - PMC5514247
EDAT- 2017/07/26 06:00
MHDA- 2017/07/26 06:01
CRDT- 2017/07/26 06:00
AID - 10.1016/j.adro.2017.01.001 [doi]
AID - S2452-1094(17)30006-4 [pii]
PST - epublish
SO  - Adv Radiat Oncol. 2017 Jan 17;2(2):140-147. doi: 10.1016/j.adro.2017.01.001.
      eCollection 2017 Apr-Jun.