@misc{oai:repo.qst.go.jp:00071274,
 author = {Yamada, Shigeru and Terashima, Koutaro and Yasuda, Shigeo and Kamada, Tadashi and Tsujii, Hirohiko and 山田 滋 and 寺嶋 広太郎 and 安田 茂雄 and 鎌田 正 and 辻井 博彦},
 month = {Sep},
 note = {Purpose/Objective: 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 2012, 198 lesions at 189 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 189 eligible patients, 132 were male and 57 female. Median age was 61.5 years. The predominant sites of relapse were 75 presacral , 77 lymph nodes, 28 perineal and 9 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, 18(+3) at 70.4GyE and 161(+6) at 73.6GyE. All toxicities in the 198 lesions at 189 patients were relatively few and mild in these patients. No grade 3 to 5 acute toxicity was observed. The local control rates in 197 lesions are 94% at three year and 89% at five years. Local control rates at 5 year were 97% 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 188 patients were 72% and 47% respectively.  Survival rates at 5 year were 20% at 67.2GyE, 24% at 70.4GyE and 51% 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., American Society for Radiation Oncology (ASTRO) Annual Meeting},
 title = {Carbon-ion Therapy For Patients With Locally Recurrent Rectal Cancer},
 year = {2013}
}