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 with locally recurrent rectal cancer. Between April 2001 and August 2012, 198 lesions at 189 patients were treated with C-ion RT. The dose was determined as 67.2 GyE and escalated to 70.4 GyE and 73.6 GyE. The local control rates in 197 lesions are 94% at 3 years and 89% at 5 years. Local control rate and survival rate at 5 years were 97% at 73.6 GyE and 51% at 73.6 GyE. In the literature, the reported 5-year survival rates for locally recurrent rectal cancer treated with resection were 20-40%. 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. In this chapter, the treatment methods and the up-to-date outcomes of carbon ion radiotherapy (C-ion RT) for the recurrent rectal cancer at the NIRS are introduced.
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