Purpose/Objective: Patients with local pelvic recurrence have an unfavorable prognosis for the high incidence of distant metastases, the infrequent feasibility of radical surgical resection and radiation dose limitation for fear of prohibitive normal tissue complications. Purpose: to evaluate the possibility to treat with relatively high radiation doses in patients with previously irradiated pelvis. Materials/Methods: All patients underwent staging work-up in the form of PET scan and CT of chest, abdomen and pelvis. Only patients with limited disease to the pelvis were included. Radiotherapy delivered using IMRT technique; the goal of the treatment is to treat 95% of the gross tumor volume plus 1 cm margin (PTV1) to a minimum dose of 59.4 Gy and 95% of the pelvic lymph nodes (PTV2) to a minimum dose of 50.4 Gy in 28 fractions in five and half weeks with concurrent chemotherapy. IMRT plan designed to match the previously treated PTV at the 50% isodose line. Daily treatment time was monitored as the patient enters the treatment room. Acute rectal and hematological toxicities were evaluated weekly during radiation using the modified RTOG morbidity criteria. Results: Ten patients were included; nine male and one female, median age is 70.9 and Karnofsky Performance scale (KPS) ≥ 70. Disease limited to the pelvis in all but one with pelvic recurrence and bilaterally positive inguinal lymph nodes. Eight previously received pelvic radiation (prostate seed implant or external irradiation to the prostate and seminal vesicle) and presented with pelvic recurrence from second primary, two presented with isolated pelvic recurrence following radical cystectomy and multiple courses of chemotherapy. All patients completed the planned treatment schedule, average PTV1, PTV 2 volumes were 286.7, 1166.8 cc3 respectively with median bladder dose of 34.4 Gy. Average daily treatment time was 32 minutes. Grade 1 rectal and hematologic toxicities were managed by medications. Conclusions: The described combined treatment is feasible and well tolerated. The possibility to treat with relatively high doses in this ongoing study may improve patients′ outcome.
Ghaly, M,
Re-irradiation for Recurrent and Second Primary Pelvic Cancer Using IMRT Technique. Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL.
http://archive.rsna.org/2005/4420583.html
