Chemoradiation in female patients with anal cancer: Patient-reported outcome of acute and chronic side effects

Abstract

Introduction: We evaluated acute and chronic side effects of 3D conformal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) in female patients with anal carcinoma and accessed correlations between dosimetric parameters and the considered toxicities. Methods: For 70 women with anal cancer treated at our department, acute and chronic side effects and quality of life (QoL) were evaluated with questionnaires using the Common Terminology Criteria for Adverse Events (CTCAE v. 4.0.) and Late Effects in Normal Tissue, Subjective, Objective Management and Analytic Scales (LentSoma) before, during, and after the treatment. Results: Forty-seven out of 70 (67%) patients completed the questionnaire and were enrolled in the study. Only poor urinary stream, loss of pubic hair during chemoradiation, and chronic vaginal dryness were observed more frequently in the 3D-CRT group compared to the IMRT group (univariable logistic regression p = .032, p = .04, p = .049, respectively). After the treatment, 43% in the 3D-CRT group and 29% in the IMRT group reported a severe loss of QoL. A higher proportion among the patients receiving a genital V20 ⩾35% showed grade 1–3 side effects such as chronic dyspareunia ( p = .035; Fisher exact test). Conclusion: Our results suggest that the use of IMRT decreases acute and chronic adverse effects although reduced QoL also occurred in the IMRT group. These effects are likely to be underreported in retrospective studies using physician-reported outcome measures.

Quality of Life After Radiotherapy for Rectal and Anal Cancer

“…Severe chronic vaginal dryness was experienced in more patients treated with 3D-CRT than IMRT. Although, IMRT was associated with a 29% rate of severe loss of overall QOL, 3D-CRT had a rate of 43%, supporting the use of IMRT to reduce side effects and improve on QOL concerns of conventional treatment (72). Also, there is a suggestion that women experience greater sexual side effects than men after IMRT, but the majority of patients diagnosed with anal cancer are women (5,530 vs 2,770 estimated new cases in the United States for women and men, respectively) (73).…”

State of the art treatment for stage I to III anal squamous cell carcinoma: A systematic review and meta-analysis

“…We included eight studies that compared chemoradiation with intensity-modulated radiotherapy (IMRT) to chemoradiation with 3D radiotherapy in stage I-III anal cancer patients. These included one single-centre RCT [58] (N = 20, risk of bias: 'some concerns'), three register-based cohort studies from the US [59][60][61] (moderate to serious risk of bias), and four single-centre retrospective cohort studies [62][63][64][65][66] (moderate to serious risk of bias). A significant advantage for IMRT was seen with respect to OS [HR 0.86 (0.76-0.98), GRADE: ⨁◯◯◯, 5,246 pts.…”

“…No significant differences were seen with respect to the outcome 'substantial reduction in quality of life' [RR 0.71 (0.32-1.57), GRADE: ⨁◯◯◯, 47 female pts. from 1 observational study [65]], CR [RR 1.00 (0.49-2.05), GRADE: ⨁⨁⨁◯, 20 pts. from 1 RCT [58]], DFS [HR 0.31 (0.09-1.05, GRADE: ⨁◯◯◯, 103 pts.…”

Intrafractional vaginal dilation in anal cancer patients undergoing pelvic radiotherapy (DILANA) – a prospective, randomized, 2-armed phase-II-trial

“…Additionally, the incorporation of FDG-PET into treatment planning offers the opportunity for sparing of functional bone marrow as another organ at risk, thus reducing hematological toxicity [12]. There are only very few data on genital toxicities like vaginal fibrosis and stenosis [13][14][15]. As mostly women are affected, this is a relevant topic.…”