Reirradiation Opportunities of Cancer Patients in a Developing Country

Purpose The aim of this study is to show reirradiation possibilities of cancer patients in a developing country like Albania. Methods and Materials From 2012 until 2015 we have reirradiated 72 patients, 42 with local and/or regional recurrence from head and neck and rectal cancer and 30 with bone metastasis from different primary tumors. Median age of patients was 56 years (28-72years). Thirty three patients were treated with a Cobalt 60 machine and thirty nine with a Linear Accelerator of 6 and 18 MV energy. They had a Karnofsky Performance State of 50-90 % and none of them could be treated surgically. We used different types of fractionations depending from the case (standard fractionation, hyperfractionation or hypofractionation). Time of reirradiation was not less than 6 months from the first radiotherapy treatment and the dose varied from 8-40Gy. Results All patients tolerated treatment. Acute toxicities were tolerable and present in 100 % and 30 % of head and neck and rectal cancer patients respectively and 10 % of patients with bone metastasis. Chronic toxicities were acceptable. One patient had a rectal-cutaneous fistula and another demonstrated signs of subocclusion 3 months after reirradiation but without necessary for intervention. At two months follow up, pain relief was seen in 86.4 % and 95 % of head and neck and rectal cancer patients respectively and 97 % of patients with bone metastasis. Anyway these percentages deteriorated over the months. Conclusions Reirradiation of patients with in-field recurrence is a feasible treatment also in developing countries. It shows improvements of quality of life with acceptable toxicity. Implementation of new and more precision devices will give us the possibility to use higher reirradiation doses with the purpose of a better local control and survival.