Effective palliation without normal tissue toxicity using low-dose ultrafractionated re-irradiation for tumor recurrence after radical or adjuvant radiotherapy

Figures & data

Table I.  The characteristics of the patients with recurrent malignant tumors of the central nervous system, and the description of low-dose ultrafractionated radiotherapy, anti-tumor response, and toxicity.

									Toxicity
Patient, sex, age, and tumor type	Prior chemotherapy regimens	Prior surgery	Prior radiotherapy	Interval to LDUF RT	LDUF RT	Symptom and its grade before LDUF RT	Clinical response after LDUF RT	Radiological response and its duration after LDUF RT	Acute	Late
#1 M, 33 years oligodendroglioma, grade II	0	2	31×1.8 Gy Total 55.8 Gy	9 years	90×0.5 Gy Total 45 Gy	Seizures (3) Headache (3) Motor neuropathy (2)	No symptoms	CR and no local recurrence at 2 years	No	No
#2 F, 40 years, oligodendroglioma, grade II	1	2	33×1.8 Gy Total 59.4 Gy	8 years	90×0.5 Gy Total 45 Gy	Seizures (3) Diplopia (3)	Seizures (2)	CR for 3 years and 8 months, then local recurrence	No	No
#3 F, 33 years, astrocytoma, grade III	0	3	33×1.8 Gy Total 59,4 Gy	8 years	90×0.5 Gy Total 45 Gy	Seizures (3)	Seizures (0)	CR for 4 years and 8 months, then local recurrence	No	No
#4 M, 47 years, oligoastrocytoma, grade III	1	2	30×2.0 Gy Total 60 Gy	18 years	102×0.5 Gy Total 51 Gy	Headache (3) Dizziness (3) Motor neuropathy (4) Fatigue (2)	Headache (0) Dizziness (0) Motor neuropathy (1) Fatigue (1)	PR at 6 months	No	No
#5 M, 42 years, cerebral neuroblastoma (PNET)	2	3	32×1.8 Gy Total 57.6 Gy	6 years	90×0.5 Gy Total 45 Gy	Seizures (3) Memory loss (3) Fatigue (2)	Seizures (0) Memory loss (3) Fatigue (2)	PR at 3 months, then progression	No	NR

LDUF RT = low-dose ultrafractionated radiotherapy; CR = complete response; PR = partial response.

NR = no referrals.

Figure 1.  Imaging of the anti-tumor response of low-dose ultrafractionated radiotherapy. (A) A patient (Table I, #1) with a rapid recurrence of grade II oligodendroglioma (arrow) 4 months after the second operation and 2 weeks before LDUF RT. A complete response is seen (B) 6 months and (C) 2 years later. T₁-weighted contrast-enhanced MRIs.

Table II.  The characteristics of the patients with recurrent rectal cancer, and the description of low-dose ultrafractionated radiotherapy, anti-tumor response, and toxicity.

									Toxicity
Patient, sex, age, and tumor type	Prior chemotherapy regimens	Prior surgery	Prior radiotherapy	Interval to LDUF RT	LDUF RT	Symptom and its grade before LDUF RT	Clinical response after LDUF RT	Radiological response and its duration after LDUF RT	Acute	Late
#6 F, 43 years, rectal cancer, T3N0M0	3	2	28×2.0 Gy Total 56 Gy	2 years	60×0.66 Gy Total 39.6 Gy	Tumor pain (4) Secretion from the natal cleft fistula (4)	Tumor pain (1) Secretion from the natal cleft fistula (2)	PR for 9 months, then local progression	No	No
#7 M, 60 years, rectal cancer, T2N0M0	2	2	28×1.8 Gy Total 50.4 Gy	1 year	83×0.5 Gy Total 41.5 Gy	Tumor pain (4) Secretion from the natal cleft fistula (4)	Tumor pain (2) Secretion from the natal cleft fistula (2)	SD for 3 months, then local progression and distant metastases	No	NR
#8 M, 62 years, rectal cancer, T4N1M0	3	1	25×2.0 Gy Total 50 Gy	4 years	99×0.5 Gy Total 49.5 Gy	Rectal discharge (3)	Rectal discharge (1)	SD for 12 months, then local progression and distant metastases	No	No

LDUF RT = low-dose ultrafractionated radiotherapy; PR = partial response; SD = stable disease.

NR = no referrals.

Table III.  The characteristics of the patients with other type of recurrent tumors treated using low-dose ultrafractionated radiotherapy.

									Toxicity
Patient, sex, age, and tumor type	Prior chemotherapy regimens	Prior surgery	Prior radiotherapy	Interval to LDUF RT	LDUF RT	Symptom and its grade before LDUF RT	Clinical response after LDUF RT	Radiological response and its duration after LDUF RT	Acute	Late
#9 F, 81 years renal cancer, T4NXM1	2	2	30×2.0 Gy Total 60 Gy (for lung metastasis)	6 years	60×0.6 Gy Total 36 Gy (for lung metastasis)	Dyspnea (3) Fatigue (3)	Fatigue (1)	PR for 10 months, then local progression	No	No
#10 M, 30 years, sacral osteosarcoma	1	1	35×2.0 Gy Total 70 Gy	5 years	60×0.5 Gy Total 30 Gy	Tumor pain (3) Motor neuropathy (3)	Tumor pain (3) Motor neuropathy (3)	PD locally and in metastases	No	NR
#11 F, 44 years, ductal carcinoma of the breast	3	1	27×1.8 Gy Total 48,6 Gy (for supra- clavicular metastases)	6 years	90×0.5 Gy Total 45 Gy (for supra- clavicular metastases)	Tumor pain (3) Lymphoedema (2)	Tumor pain (1) Lymphoedema (2)	SD at 6 months	No	No

LDUF RT = low-dose ultrafractionated radiotherapy; PR = partial response; PD = progressive disease; SD = stable disease.

NR = no referrals.