Chemoradiotherapy for squamous cell carcinoma of the anal canal: Comparison of one versus two cycles mitomycin-C

White, E.C.; Goldman, Kelly E.; Aleshin, Alexey; Lien, W.W.; Rao, Aroor R.

doi:10.1016/j.radonc.2015.08.015

Cited by 25 publications

(9 citation statements)

References 17 publications

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“…One option could be to limit the administration of mitomycin to only one cycle at the beginning of the RT-CHT course. As shown in the retrospective study by White et al, comparing anal cancer patients undergoing concurrent RT-CHT with either one or two cycles of mitomycin, patients receiving one cycle only had lower rates of clinically significant acute HT including neutropenia, with three treatment-related deaths observed in the cohort of patients receiving two cycles of mitomycin and due to neutropenic sepsis [ 25 ]. Conversely, loco-regional control and survival outcomes were found to be similar, regardless of the number of cycles administered [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…As shown in the retrospective study by White et al, comparing anal cancer patients undergoing concurrent RT-CHT with either one or two cycles of mitomycin, patients receiving one cycle only had lower rates of clinically significant acute HT including neutropenia, with three treatment-related deaths observed in the cohort of patients receiving two cycles of mitomycin and due to neutropenic sepsis [ 25 ]. Conversely, loco-regional control and survival outcomes were found to be similar, regardless of the number of cycles administered [ 25 ]. Another approach that can be considered is the concurrent use of cisplatin instead of mitomycin, which was demonstrated to be well-tolerated and to yield to similar survival outcomes as mitomicin in the experimental arm of the ACT II trial [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

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Concurrent Chemoradiation in Anal Cancer Patients Delivered with Bone Marrow-Sparing IMRT: Final Results of a Prospective Phase II Trial

Arcadipane

Silvetti

Olivero

et al. 2021

JPM

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We investigated the role of the selective avoidance of haematopoietically active pelvic bone marrow (BM), with a targeted intensity-modulated radiotherapy (IMRT) approach, to reduce acute hematologic toxicity (HT) in anal cancer patients undergoing concurrent chemo-radiation. We designed a one-armed two-stage Simon’s design study to test the hypothesis that BM-sparing IMRT would improve by 20% the rate of G0–G2 (vs. G3–G4) HT, from 42% of RTOG 0529 historical data to 62% (α = 0.05; β = 0.20). A minimum of 21/39 (54%) with G0–G2 toxicity represented the threshold for the fulfilment of the criteria to define this approach as ‘promising’. We employed 18FDG-PET to identify active BM within the pelvis. Acute HT was assessed via weekly blood counts and scored as per the Common Toxicity Criteria for Adverse Effects version 4.0. From December 2017 to October 2020, we enrolled 39 patients. Maximum observed acute HT comprised 20% rate of ≥G3 leukopenia and 11% rate of ≥G3 thrombocytopenia. Overall, 11 out of 39 treated patients (28%) experienced ≥G3 acute HT. Conversely, in 28 patients (72%) G0–G2 HT events were observed, above the threshold set. Hence, 18FDG-PET-guided BM-sparing IMRT was able to reduce acute HT in this clinical setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Concurrent Chemoradiation in Anal Cancer Patients Delivered with Bone Marrow-Sparing IMRT: Final Results of a Prospective Phase II Trial

Arcadipane

Silvetti

Olivero

et al. 2021

JPM

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“…Goodman et al identified a significant reduction of grade ≥3 HT and treatment interruptions of 32% and 26%, respectively, with equivalent clinical outcomes, and suggested capecitabine as a suitable alternative to 5-FU 29 . In cases where dose constraints are not achievable, some consider following a European approach using single-dose MMC in select patients, which likely has a greater effect on HT than RT 30, 31. Additional studies will be required to assess the combined impact of varying pelvic radiation dose, elective treatment of inguinal nodes, and type of chemotherapy on both clinical outcomes and HT.…”

Section: Discussionmentioning

confidence: 99%

18F-FDG PET Predicts Hematologic Toxicity in Patients with Locally Advanced Anal Cancer Treated With Chemoradiation

David

Yue

Blas

et al. 2019

Advances in Radiation Oncology

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PurposeHematologic toxicity (HT) during chemoradiation therapy (CRT) for anal cancer can lead to treatment breaks that compromise efficacy. We hypothesized that CRT-induced HT correlates with changes in active bone marrow (ABM) characterized by pre-/post-CRT positron emission tomography (PET)/computed tomography.Methods and materialsData from 36 patients with anal cancer who were treated with 18F-fluorodeoxyglucose PET/computed tomography scans 2 weeks before and 6 to 16 weeks after CRT were analyzed. Complete blood counts with differential within 2 weeks from, weekly during, and 2 week after treatment were obtained. HT was defined as baseline complete blood count change to nadir and posttreatment recovery. Total bone marrow was segmented into 2 subregions: lumbosacral (LS) pelvis (L5 vertebrae, sacrum, and coccyx) and lower pelvis (LP) (ilium, femoral head/neck, and greater and lesser trochanter). PET ABM was characterized as the volume having standard uptake value (SUV) greater than the mean uptake of unirradiated extrapelvic bone marrow. PET variables of pre-/post-CRT and HT predictors were analyzed by linear regression.ResultsAverage pelvic ABM was significantly reduced from 52% to 41% in pre- to post-CRT PET scans for all patients (P = .0012). Regional analysis indicated significant post-CRT reduction of LS-ABM (P < .0001) and LP-ABM (P = .006). Linear regression analysis identified post-CRT SUVmean, differential ΔSUVmean, and ΔABM as correlating significantly with pre- and posttreatment HT. ΔWBC linearly correlated with ΔABM of LS and LP pelvis (P = .033 and P = .028, respectively). Dosimetrically, ABM was sensitive to higher radiation doses (>50 Gy) in terms of acute hematologic ΔWBC (P = .021) and ΔANC(P = .028). HT increased with increasing volume of ABM receiving 40 Gy. The results also suggest that ABM V40 Gy ≤ 20% to 25% may significantly reduce the risk of HT.ConclusionsHT was significantly associated with ΔABM in patients with anal cancer who were treated with CRT. LS-ABM was a robust surrogate for evaluating CRT-induced HT. Our results suggest implementation of ABM dosimetric constraints, V40 Gy ≤ 20-25%, may significantly reduce HT and lead to decreased treatment delays associated with clinical outcomes.

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“…The known risk factors for anal cancer include a positive HIV status, a history of anoreceptive sexual intercourse, HPV infection, smoking, and female gender. The patient population in our study was different from that in prior studies (24)(25)(26). First, all patients with anal SCC were tested for HIV and were negative.…”

Section: Discussionmentioning

confidence: 99%

Real world survival data of a rare malignancy: Anal cancer results in HIV negative patients from Turkey

Esin

Yıldız

Laçin

et al. 2018

Turk J Gastroenterol

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Chemoradiotherapy for squamous cell carcinoma of the anal canal: Comparison of one versus two cycles mitomycin-C

Cited by 25 publications

References 17 publications

Concurrent Chemoradiation in Anal Cancer Patients Delivered with Bone Marrow-Sparing IMRT: Final Results of a Prospective Phase II Trial

Concurrent Chemoradiation in Anal Cancer Patients Delivered with Bone Marrow-Sparing IMRT: Final Results of a Prospective Phase II Trial

18F-FDG PET Predicts Hematologic Toxicity in Patients with Locally Advanced Anal Cancer Treated With Chemoradiation

Real world survival data of a rare malignancy: Anal cancer results in HIV negative patients from Turkey

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