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Clinical safety and efficacy of salvage reirradiation for upper abdominal malignancies

  • Jason Joon Bock Lee
  • Seo Hee Choi
  • Jung Ho Im
  • Jinsil SeongEmail author
Original Article
  • 22 Downloads

Abstract

Purpose

Reirradiation has the potential to provide effective local control of upper abdominal malignancies. This study aimed to evaluate the safety and efficacy of reirradiation for upper abdominal malignancies.

Methods

A total of 42 patients with a history of prior radiotherapy (RT) received reirradiation for abdominal malignancies between 2005 and 2017. Each patient’s medical records, contours, and dose distribution for both RT courses were reviewed. The median dose of the prior RT was 50.0 Gy (range, 30.0–60.0 Gy) and the median dose of reirradiation was 45.0 Gy (range, 15.0–75.0 Gy).

Results

With a median follow-up of 10.9 months, the median infield-failure-free survival (IFFS) rate was 9.2 months. Gross tumor volume (GTV) significantly related to IFFS in both the univariate (p = 0.009) and multivariate analyses (p = 0.024), and patients with a GTV of <60.0 mL had an improved IFFS (p = 0.001). Four patients experienced ≥grade 3 late toxicities. In the retrospective dose reconstruction analysis in these patients, the cumulative dose to the most exposed 2 cc (D2cc) of the duodenum was >60.0 Gy (range, 60.1–73.7 Gy). In the univariate analysis, the D2cc of the duodenum and a preexisting duodenal ulcer identified using endoscopy prior to reirradiation significantly correlated with late severe toxicity (p = 0.021 and 0.017, respectively).

Conclusions

Reirradiation for upper abdominal malignancies could be safely performed for patients without preexisting gastrointestinal morbidity unless the duodenum received excessive radiation doses. Reirradiation could also provide substantial IFFS, especially for patients with a GTV of <60.0 mL.

Keywords

Local control Toxicity Duodenum Gross tumor volume Radiotherapy dosage 

Klinische Sicherheit und Wirksamkeit der Salvage-Rebestrahlung bei bösartigen Tumoren im oberen Abdominalbereich

Zusammenfassung

Zielsetzung

Eine Rebestrahlung hat das Potenzial, bösartige Tumore im oberen Abdominalbereich lokal zu kontrollieren. Diese Studie dient dem Zweck, festzustellen, ob eine Rebestrahlung in diesem Bereich sicher und effizient ist.

Methoden

Insgesamt 42 Patienten mit einer Vorgeschichte von Bestrahlungen erhielten zwischen 2005 und 2017 eine Rebestrahlung für bösartige Tumore im oberen Abdominalbereich. Die medizinische Krankenakte, die Umrisse der Tumore und die Bestrahlungsdosen von beiden Behandlungen wurden bewertet. Der Mittelwert der ersten Bestrahlung lag bei 50,0 Gy (Spanne 30,0–60,0 Gy), der Mittelwert der Rebestrahlung betrug 45,0 Gy (Spanne 15,0–75,0 Gy).

Ergebnisse

Mit einer Durchschnittszeit von 10,9 Monaten lag die Durchschnittsrate des Infield-Failure-Free-Bereichs (IFFS) bei 9,2 Monaten. Das Gesamtvolumen des Tumors (GTV) zeigte große Wirkung in Verbindung mit IFFS, in der univariaten (p = 0,009) sowie in der multivariaten Analyse (p = 0,024). Patienten mit einem GTV von <60,0 ml hatten einen verbesserten IFFS (p = 0,001). Vier Patienten erlitten im Verlauf eine verzögerte Toxizität ≥Grad 3. Bei der retrospektiven Analyse der Dosen dieser Patienten stellte sich heraus, dass die kumulative Dosis der am meisten exponierten 2 cc (D2cc) des Duodenums >60,0 Gy betrug (Spanne 60,1–73,7 Gy). In der univariaten Analyse zeigte sich, dass der D2cc-Gehalt des Duodenums und ein prädisponierter Duodenalulkus, der vor der Rebestrahlung mittels Endoskopie identifiziert wurde, direkt mit einer verzögerten Toxizität (jeweils p = 0,021 bzw. 0,017) in Verbindung gebracht werden konnte.

Schlussfolgerung

Eine Rebestrahlung bei bösartigen Tumoren im oberen Abdominalbereich kann bei Patienten, bei denen keine prädisponierte gastrointestinale Erkrankung vorliegt, sicher durchgeführt werden, es sei denn, das Duodenum erhielt exzessive Bestrahlungsdosen. Rebestrahlung kann zudem auch erheblich zu IFFS beitragen, vor allem bei Patienten mit einem GTV von <60,0 ml.

Schlüsselwörter

Lokale Kontrolle Toxizität Duodenum Gesamtvolumen des Tumors Bestrahlungsdosis 

Notes

Compliance with ethical guidelines

Conflict of interest

J.J.B. Lee, S.H. Choi, J.H. Im, and J. Seong declare that they have no competing interests.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

66_2018_1420_MOESM1_ESM.pdf (121 kb)
Supplementary tables with details of adverse events, characteristics of patients with severe late toxicites, and results of subgroup analyses of long-term survivors

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation Oncology, Yonsei Cancer CenterYonsei University College of MedicineSeoulKorea (Republic of)

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