ESTRO 2023

Session Item

Lower GI

Session Code: 6012

Session Type: Poster (Digital)

Track: Clinical

Re-irradiation in locally recurrent rectal cancer: a national survey of the AIRO GI study group

GIOVANNA MANTELLO, Italy

Presentation Number: PO-1406

Abstract

Abstract Title:

Re-irradiation in locally recurrent rectal cancer: a national survey of the AIRO GI study group

Authors:

GIOVANNA MANTELLO¹, Elena Galofaro¹, Clelia Di Carlo¹, Sabrina Montrone², Luciana Caravatta³, Antonino De Paoli⁴, Maria Antonietta Gambacorta⁵, Domenico Genovesi³, Marco Lupattelli⁶, Gabriella Macchia⁷, Rita Marina Niespolo⁸, Francesca Valvo⁹, Donatella Arpa¹⁰, Melissa Scricciolo¹¹, Valentina Chiloiro⁵, Giampaolo Montesi¹², Antonio Pontoriero¹³, Vittorio Donato¹⁴, Pierfrancesco Franco¹⁵

¹Azienda Ospedaliero Universitaria delle Marche, Radiotherapy Department, Ancona, Italy; ²Pisa University, Department of Radiotherapy, Pisa, Italy; ³SS Annunziata Hospital, Department of Radiation Oncology, Chieti, Italy; ⁴Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Division of Radiation Oncology, Aviano, Italy; ⁵Università Cattolica del Sacro Cuore, Departments of Radiation Therapy, Roma, Italy; ⁶University of Perugia and Perugia General Hospital, Radiation Oncology Section, Perugia, Italy; ⁷Fondazione di Ricerca e Cura 'Giovanni Paolo II'- Catholic University of Sacred Heart, Radiotherapy Unit, Campobasso, Italy; ⁸Azienda Ospedaliera San Gerardo, Radiotherpy Unit, Monza, Italy; ⁹Fondazione CNAO, National Center of Oncological Hadrontherapy, Pavia, Italy; ¹⁰IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Radiotherapy Unit, Meldola, Italy; ¹¹Ospedale dell’Angelo, UOC di Radioterapia Oncologica Mestre, Venezia Mestre, Italy; ¹²ULSS5, Radiotherapy Unit, Rovigo, Italy; ¹³University of Messina, Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy; ¹⁴San Camillo-Forlanini Hospital, Radiation Oncology Division, Oncology and Speciality Medicine Department, Roma, Italy; ¹⁵University of Eastern Piedmont, Maggiore della Carità University Hospital, Department of Translational Medicine, Department of Radiation Oncology, Novara, Italy

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Purpose or Objective

Radical resection (R0) represents the best curative treatment for local recurrence (LR) of rectal cancer and represents the only therapeutic option that can provide long-term survival. Re-irradiation (re-RT) can increase the rate of R0 resection. Currently, guidelines on Re-RT for LR rectal cancer are lacking. The Italian Association of Radiation and clinical Oncology study group for gastrointestinal tumors (AIRO-GI) disseminated a national survey to investigate the current clinical practice of external beam radiation therapy (EBRT) in this group of patients.

Material and Methods

In February 2021, the survey was designed and then distributed to members of the GI working group. The questionnaire consisted of 40 questions regarding center characteristics, clinical indications, doses, and treatment techniques of re-RT for LR rectal cancer.

Results

Thirty-seven questionnaires were collected. Re-RT was reported as an option for neoadjuvant treatment in resectable and nonresectable disease by 55% and 75% of respondents, respectively. In most centers, long-course treatment with 30-40 Gy (1.8-2 Gy/die, 1.2 Gy bid) and hypo-fractionated regimen of 30-35 Gy in 5 fractions were used. A total dose of 90-100 Gy as EqD2 dose (alfa/beta=5 Gy), taking into account previous treatment, was delivered by 46% of respondents. IMRT/VMAT and daily IGRT protocols were used in 94% of centers.

Conclusion

Our survey showed high quality of treatment and management of rectal cancer LR. Considerable variation was observed in terms of dose and fractionation, highlighting the need for consensus on a common treatment strategy that could be validated in prospective studies.