Purpose:
The incidence of anal cancer in patients with kidney transplants has increased. The definitive treatment for anal cancer is chemotherapy and intensity-modulated radiation therapy. In kidney transplant recipients, sparing the pelvic kidney in the process of delivering radiation to the anus can be challenging. Intensity-modulated proton therapy (IMPT) has been proposed as an alternative to intensity-modulated radiation therapy for the treatment of anal cancer in this population, given its increased ability to spare organs-at-risk.
Case Series:
We present 4 cases of patients with transplanted pelvic kidneys who subsequently developed anal cancer and were treated with IMPT from 2017 to 2019.
Conclusion:
Use of IMPT appears to be an acceptable option for the treatment of anal cancer in patients with a pelvic kidney.
survival (OS). Recursive partitioning analysis (RPA) was done to determine a cutoff point of KPS for improved CSS and OS. Results: Fifty-eight patients met study criteria with median age of 84.9 years, median KPS of 70, median dose per fraction of 10 Gy, and median number of fractions of 5. Twenty-three (39.7%) were adenocarcinomas, 17 (29.3%) squamous cell carcinomas, and 18 (31.0%) not biopsied. Three-year rates of LR, RR, RP, CSS, and OS were 39.5%, 43.9%, 34.5%, 83.2%, and 69.2% respectively. On MVA, adenocarcinoma histology (HRZ6.36; PZ.01) was associated with higher LR, while T1 tumors had lower LR (HRZ0.20; P<.01). On MVA, higher KPS was associated with lower LR (HRZ0.92; P<.01) and RR (HRZ0.94; P<.01). On MVA, older age (HRZ1.19; PZ.04) and prior lung cancer (HRZ7.75; PZ.01) were associated with lower CSS, while not actively smoking (HRZ0.14; PZ.03) was associated with higher CSS. On MVA, only higher KPS (HRZ0.91; P<.01) was associated with higher OS. On MVA, not being on an ACE-I (HRZ3.49; PZ.02) was associated with higher rates of RP. On RPA, KPS of 75 was the breakpoint for improved CSS and OS. Conclusion: In this multi-center review of patients 80 years old treated with definitive lung SBRT, treatment was well tolerated with excellent 5-year CSS estimated rates. Patients 80 years old with KPS of 70 are effectively managed with SBRT. The association between ACE-I usage and lower rates of RP is hypothesis generating.
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