Pelvic re-irradiation using stereotactic ablative radiotherapy (SABR): A systematic review.

BACKGROUND AND PURPOSE: To perform a systematic review regarding the use of stereotactic ablative radiotherapy (SABR) for the re-irradiation of recurrent malignant disease within the pelvis, to guide the clinical implementation of this technique. MATERIAL AND METHODS: A systematic search strategy was adopted using the MEDLINE, EMBASE and Cochrane Library databases. RESULTS: 195 articles were identified, of which 17 were appropriate for inclusion. Studies were small and data largely retrospective. In total, 205 patients are reported to have received pelvic SABR re-irradiation. Dose and fractionation schedules and re-irradiated volumes are highly variable. Little information is provided regarding organ at risk constraints adopted in the re-irradiation setting. Treatment appears well-tolerated overall, with nine grade 3 and six grade 4 toxicities amongst thirteen re-irradiated patients. Local control at one year ranged from 51% to 100%. Symptomatic improvements were also noted. CONCLUSIONS: For previously irradiated patients with recurrent pelvic disease, SABR re-irradiation could be a feasible intervention for those who otherwise have limited options. Evidence to support this technique is limited but shows initial promise. Based on the available literature, suggestions for a more formal SABR re-irradiation pathway are proposed. Prospective studies and a multidisciplinary approach are required to optimise future treatment.

Palliative radiotherapy in patients with esophageal carcinoma: A retrospective review.

PURPOSE: Palliative radiotherapy has traditionally been used as a noninvasive means of palliating dysphagia in patients with incurable esophageal cancer. Insertion of an esophageal stent is a traditional alternative and newer treatment modalities such as brachytherapy and laser therapy are being increasingly investigated and employed. There are few large series in the literature which examine the role of short palliative radiotherapy regimens in this patient group. This retrospective review aims to demonstrate the useful role that external beam radiotherapy can have in the palliation of patients with incurable esophageal carcinoma. METHODS AND MATERIALS: One hundred forty-eight patients with histologically proven esophageal cancer, who were unsuitable for radical treatment, were identified. Notes were reviewed to determine baseline characteristics, indications for radiotherapy, response to treatment, need for further intervention, time to further intervention, and survival. RESULTS: The median age of patients who received palliative radiotherapy was 74 years (range, 31-91). Forty-nine percent of patients (n = 73) were performance status 2 or 3, 70% (n = 103) had adenocarcinoma, 58% (n = 86) had locally advanced disease, and 28% (n = 41) had metastatic disease. Ninety-three percent of patients (n = 138) complained of dysphagia prior to radiotherapy. Eighty-nine percent of patients (n = 132) received a dose of 20 Gy in 5 fractions. Only 2 patients (1%) failed to complete the prescribed course of treatment. Following radiotherapy, 75% of patients experienced an improvement in dysphagia and 25% of patients gained weight. Twenty-six percent of patients (n = 38) required subsequent insertion of an esophageal stent and a further 3% (n = 5) received retreatment with radiotherapy. The median stent (and retreatment)-free survival was 4.9 months. Median overall survival was 6.1 months. CONCLUSIONS: Despite a lack of randomized comparison to other modalities, external beam radiotherapy remains an effective, noninvasive, and generally well-tolerated means to palliate dysphagia in selected patients with incurable esophageal carcinoma.