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Re-Irradiation With Proton Beam Therapy for Localized Perineural Spread Following Presacral Recurrence in Sigmoid
Masahiko Harada1, Takashi Saito1, Toshiki Ishida1
1Department of Radiation Oncology, University of Tsukuba, Tsukuba, JPN.
Cureus
|April 23, 2024
Summary
Proton beam therapy effectively managed localized perineural spread (PNS) in sacral nerves from recurrent colon cancer. Re-irradiation with proton beam therapy (PBT) achieved recurrence-free survival in a challenging case.
Area of Science:
- Oncology
- Radiation Oncology
- Surgical Oncology
Background:
- Colon cancer recurrence can involve complex anatomical sites, such as the presacral region.
- Perineural spread (PNS) to sacral nerves presents a management challenge, especially when radical resection is not feasible.
Observation:
- A patient with sigmoid colon cancer recurrence exhibited localized PNS to the left S2 nerve three years after initial proton beam therapy (PBT) and capecitabine.
- Magnetic resonance imaging revealed nerve swelling and abnormal fluorodeoxyglucose uptake, confirming PNS.
Findings:
- Initial treatment involved PBT (75 Gy RBE/25 fractions) combined with capecitabine for presacral recurrence.
- Successful re-irradiation with PBT (75 Gy RBE/25 fractions) was performed, carefully managing dose overlap and adjacent organ toxicity.
- The patient remained recurrence-free for 1.5 years post-reirradiation.
Implications:
- This case demonstrates the potential efficacy of proton beam therapy (PBT) for managing localized perineural spread in recurrent colon cancer.
- Further research is warranted to explore the broader application and long-term outcomes of PBT in similar complex oncological scenarios.
