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J.Jpn. Surg. Soc.. 118(4): 414-421, 2017

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National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan

Shigeru Yamada, Yuka Isozaki, Shohei Kawashiro, Tadashi Kamada

To improve the long-term local control and survival in patients with 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 tolerability and effectiveness of carbon ion radiotherapy (CIRT) in patients with locally recurrent rectal cancer. Between 2001 and 2015, 239 lesions in 229 patients were treated with CIRT. The initial dose was 67.2 Gy (relative biological effectiveness [RBE]), escalated to 70.4 Gy (RBE) and 73.6 Gy (RBE). The 5-year local control rate and survival rate at 73.6 Gy (RBE) in 207 patients were 97% and 51%, respectively. More recently, treatment with a spacer has been used for cases with lesions occurring too close to the intestines. In an analysis of 91 cases, the 5-year local control rate was 90%, with 5-year survival of 30%. We also treat patients with recurrence following pelvic X-ray irradiation. In an analysis of 67 cases, grade 3+ acute adverse effects were observed in 7, and late effects were seen in 13. The survival rate was 65% at 3 years and 42% at 5 years, which is a good result in this population. Heavy-ion particle radiotherapy has been shown to be an effective therapeutic tool for patients with recurrent colorectal cancer following X-ray treatment.

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