Feasibility and morbidity of combined hyperthermia and radiochemotherapy in recurrent rectal cancer - Preliminary results

Background: The local recurrence rate of colorectal cancer has been
significantly reduced due to the use of combined radiochemotherapy.
Despite this improvement regarding locally advanced tumour
recurrences, the treatment strategy for pre-treated patients
remains difficult and unresolved. Patients and Methods: We analysed
treatment and follow-up data of 14 patients with local recurrence
of rectal cancer who were treated with radiation therapy (RT),
chemotherapy (CT) and regional hyperthermia (RHT) from November
1997 to December 2001. Nine of these patients had received
irradiation and CT (=pre-treated patients) in the past. For this
group, 30.6-39.6 Gy RT, 5-fluorouracil (5-FU) as a continuous
infusion over 5 days per week (350 mg/m(2)/24 h) combined with RHT
twice a week was given. The 5 remaining patients (=not pre-treated)
received conformal irradiation of 45 Gy with a boost between 9 and
14.4 Gy, combined with continuous infusion of 5-FU on days 1-4, and
29-33 (500 mg/m(2)/24 h), and RHT twice a week. Response to therapy
was evaluated by means of computed tomography (CT) or magnetic
resonance imaging (MRI) and by clinical follow-up. Results: Among
13 evaluated cases, the overall objective response rate was 54% (5
complete responses, 2 partial responses). At mean follow-up of 13.9
months (range 5-32 months) 7 patients were alive. Conclusion: The
therapeutic regimen appears to be active in the treatment of local
recurrences of rectal cancer. Larger-scaled studies are needed to
evaluate the potency of hyperthermia in this therapeutic strategy.