Radiation therapy for de novo anorectal cancer in patients with a history of prostate radiation therapy Journal Article


Authors: Hilal, L.; Wu, A. J.; Reyngold, M.; Cuaron, J. J.; Navilio, J.; Romesser, P. B.; Dreyfuss, A.; Yin, S.; Zhang, Z.; Bai, X.; Berry, S. L.; Zinovoy, M.; Nusrat, M.; Pappou, E.; Zelefsky, M. J.; Crane, C. H.; Hajj, C.
Article Title: Radiation therapy for de novo anorectal cancer in patients with a history of prostate radiation therapy
Abstract: Introduction: Radiation therapy (RT) for anorectal cancer after prior prostate cancer RT is usually avoided due to concern for complications. Data on this topic is scarce. Our aim was to evaluate tolerability, toxicity, and clinical outcomes associated with a second course of pelvic radiation in men with de novo anorectal cancers previously treated with RT for prostate cancer. Materials/methods: We conducted a single-institution retrospective study of men treated with RT for rectal or anal cancer after prior prostate RT. Toxicity data were collected. Treatment plans were extracted to assess doses to organs at risk and target coverage. Cumulative incidence was calculated for local and distant progression. Kaplan-Meier curves were used to estimate overall survival (OS) and progression-free survival (PFS). Results: We identified 26 patients who received anorectal RT after prostate cancer RT: 17 for rectal cancer and 9 for anal cancer. None had metastatic disease. Prior prostate RT was delivered using low dose rate brachytherapy (LDR), external beam RT (EBRT), or EBRT + LDR. RT for rectal cancer was delivered most commonly using 50.4Gy/28 fractions (fr) or 1.5 Gy twice-daily to 30-45 Gy. The most used RT dose for anal cancer was 50Gy/25 fr. Median interval between prostate and anorectal RT was 12.3 years (range:0.5 - 25.3). 65% and 89% of rectal and anal cancer patients received concurrent chemotherapy, respectively. There were no reported ≥Grade 4 acute toxicities. Two patients developed fistulae; one was urinary-cutaneous after prostate LDR and 45Gy/25fr for rectal cancer, and the other was recto-vesicular after prostate LDR and 50Gy/25fr for anal cancer. In 11 patients with available dosimetry, coverage for anorectal cancers was adequate. With a median follow up of 84.4 months, 5-yr local progression and OS were 30% and 31% for rectal cancer, and 35% and 49% for anal cancer patients, respectively. Conclusion: RT for anorectal cancer after prior prostate cancer RT is feasible but should be delivered with caution since it poses a risk of fistulae and possibly bleeding, especially in patients treated with prior LDR brachytherapy. Further studies, perhaps using proton therapy and/or rectal hydrogel spacers, are needed to further decrease toxicity and improve outcomes. Copyright © 2022 Hilal, Wu, Reyngold, Cuaron, Navilio, Romesser, Dreyfuss, Yin, Zhang, Bai, Berry, Zinovoy, Nusrat, Pappou, Zelefsky, Crane and Hajj.
Keywords: fistula; toxicity; anorectal cancer; prostate radiation therapy; second course of pelvic rt
Journal Title: Frontiers in Oncology
Volume: 12
ISSN: 2234-943X
Publisher: Frontiers Media S.A.  
Date Published: 2022-09-15
Start Page: 975519
Language: English
DOI: 10.3389/fonc.2022.975519
PROVIDER: scopus
PMCID: PMC9521738
PUBMED: 36185296
DOI/URL:
Notes: Article -- Export Date: 1 November 2022 -- Source: Scopus
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Melissa Remis Zinovoy
    50 Zinovoy
  2. Zhigang Zhang
    431 Zhang
  3. Michael J Zelefsky
    755 Zelefsky
  4. Sean L Berry
    71 Berry
  5. Marsha Reyngold
    104 Reyngold
  6. Abraham Jing-Ching Wu
    404 Wu
  7. Carla Hajj
    165 Hajj
  8. Paul Bernard Romesser
    194 Romesser
  9. John Jacob Cuaron
    143 Cuaron
  10. Christopher   Crane
    205 Crane
  11. Emmanouil Pappou
    93 Pappou
  12. Maliha Nusrat
    14 Nusrat
  13. Xing Bai
    6 Bai