@misc{oai:repo.qst.go.jp:00069492,
 author = {Yamada, Shigeru and Yanagi, Takeshi and Hara, Ryusuke and Katou, Hirotoshi and Kamada, Tadashi and Tsujii, Hirohiko and 山田 滋 and 柳 剛 and 原 竜介 and 加藤 博敏 and 鎌田 正 and 辻井 博彦},
 month = {Sep},
 note = {Purpose/Objective(s): To improve long-term local control and
survival of locally recurrent rectal cancer, we have initiated a radiation
dose-escalation trial using carbon ion beams. The purpose of this study is
to evaluate the tolerance for and effectiveness of carbon ion radiotherapy
in patients locally recurrent rectal cancer
Materials/Methods: Between April 2001 and August 2007, 95 lesions at 90
patients were enrolled onto this study. Criteria for trial eligibility were
confirmation of locally recurrent rectal cancers without distant metastases
based on CT, MRI and PET findings and ECOG performance score 0,1,2.
Contraindications for trial entry included pelvic bone destruction. Carbon
beams of 290, 350 and 400 MeV/nucleon energy were generated in the HIMAC
synchrotron. The dose was determined as 67.2GyE and escalated to 70.4GyE,
73.6GyE. Of the 90 eligible patients, 57 were male and 33 female. Median age
was 62.5 years. The predominant sites of relapse were 41 presacral , 26
lymph nodes, 15 perineal and 8 anastomosis. Toxicities on organs were
assessed according to the NCI-CTC classification. Tumor response was defined
by the RESIST scoring system. Local recurrence was defined in terms of
lesions occurring in the tumor bed. Survival curves were estimated by the
Kaplan and Meier method.
Results: Ten patients received radiation dose at 67.2GyE, 19(+1) at 70.4GyE
and 63(+4) at 73.6GyE. All toxicities in the 95 lesions at 90 patients were
relatively few and mild in these patients. No grade 3 to 5 acute toxicity
was observed. The local control rates in 91 lesions are 89% at three year
and 81% at five years. Local control rates at 3 year were 70% at 67.2GyE,
84% at 70.4GyE and 93% at 73.6GyE. In terms of symptomatic response within 3
months after treatment, pain improved in 97% of the symptomatic cases. Pain
relief was maintained at one year in 67%, 91% and 100% of the patients
treated with 67.2GyE, 70.4GyE and 73.6GyE, respectively. The three and five
year overall survival rate in 90 patients were 60% and 43% respectively.
Survival rates at 5 year were 24% at 67.2GyE, 32% at 70.4GyE and 57% at
73.6GyE. In the literature, the reported five-year survival rates for
locally recurrent rectal cancer treated with resection were 20 to 40%.
Conclusions: Carbon ion radiotherapy seems to be a safe and effective
modality in the management of locally recurrent rectal cancer, providing
good local control and offering a survival advantage without acceptable
morbidity., 50th Annual Meeting American Society for Therapeutic Radiology and Oncology},
 title = {Carbon Ion Therapy for Patients with Locally Recurrent Rectal Cancer},
 year = {2008}
}