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.
Background
Cutaneous squamous cell carcinoma of the head/neck (CSCCHN) is common due to chronic sun exposure. As CSCCHN highly expresses EGFR, we prospectively studied postoperative concurrent cetuximab with radiotherapy for locally advanced CSCCHN (LA‐CSCCHN).
Materials and methods
Single‐institutional phase II trial of LA‐CSCCHN (NCT XXXX). Adjuvant radiation was given with concurrent cetuximab. Primary endpoint of 2‐year LRC and secondary objectives of 2‐year disease‐free survival (DFS) and 2‐year OS were assessed by Kaplan–Meier analysis.
Results
Twenty‐four patients ages 47–88 (median 71 years) were treated from 2014 to 2017. Fourteen patients had T3/4 disease, 5 had N1 disease, and 7 were N2/3. At median follow‐up of 42 months, median OS and DFS was not reached and 64 months. Two‐year OS was 75%, 2‐year DFS was 70.8%. LRC was 91.1% at 2 years. All grade 3 adverse events were related to skin toxicity (12.5% radiation‐related dermatitis, 16.7% cetuximab‐related rash).
Conclusions
LRC compares favorably to historical data examining postoperative radiation alone but requires further investigation.
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