IMRT for locally advanced anal cancer: clinical experience of the Montpellier Cancer Center

Abstract

PurposeTo assess outcomes of patients with carcinoma of the anal canal (CAC) treated with intensity-modulated radiation therapy (IMRT).Method and materialsFrom August 2007 to January 2011, seventy-two patients suffering from CAC were treated with IMRT. Concurrent chemotherapy was added in case of locally advanced tumors. Radiation course consisted in delivering an initial plan to the PTV1 defined as the primary tumor and the risk area including pelvic and inguinal nodes. Forty-five Gy in daily 1.8 Gy-daily fractions were delivered five days a week. A second plan of 14.4-20 Gy to the primary tumor (PTV2) was administered in 1.8-2 Gy-daily fractions, 5 days a week. We present here the results of dosimetry, toxicities, and clinical outcome of the first 39 patients with a median follow-up of 24 months.ResultsThirty-one women and eight men were included in the present analysis. Tumors were classified as stages I, II, III and IV in 2, 7, 27 and 2 patients, respectively. Median age was 59 years (range, 38-85). Radiotherapy alone (RT) or combined with chemotherapy (RCT) were delivered in 6 (15%) and 33 (85%) patients, respectively.Six patients (15%) required a treatment break ≥ 3 days, and median time for treatment break was 8 days (range, 3-14 days). Acute grade 3 gastrointestinal (GI) and genitourinary (GU) toxicities were seen in 10 and 5% of patients, respectively. Grade 4 toxicity was only hematologic and occurred in 12% patients receiving RCT. With a median follow-up of 24 months, no patient experienced any late grade 4 toxicity. The 2-year overall survival rate was 89%, the 2-year local relapse free survival was 77% and the 2-year colostomy-free survival rate was 85%.ConclusionIMRT is well tolerated with acceptable treatment interruption allowing dose escalation.

Efficacy and safety of helical tomotherapy with daily image guidance in anal canal cancer patients

“…Overall, grade 3 acute toxicity was observed in 19 patients (24%), mainly as erythema (n ¼ 16). Grade 3 diarrhea was recorded in 7/78 (8.9%), a rate which seems to be significantly lower than those reported in the published randomized trials, and comparing well with other series of IMRT in anal cancer patients [15,16]. No grade 4 toxicity was recorded in our patients.…”

“…Using IGRT, the treatment volume can be reduced by reducing the size of the necessary margins taking into account for inaccuracies in target position and patient setup, with a consequent reduction of toxicity rates. IMRT and IGRT have been recently adopted and prospectively evaluated also in the treatment of anal cancer patients, and results are promising in terms of local control (LC) and toxicity [14][15][16]. However, the sample size of IMRT studies was often limited, with also short follow-up time (often524 months).…”

Intensity-Modulated Radiation Therapy with Simultaneous Integrated Boost Combined with Concurrent Chemotherapy for the Treatment of Anal Cancer Patients: 4-Year Results of a Consecutive Case Series

“…Hence, a large amount of normal tissues was generally included within treatment fields, leading to consistent unintended dose to critical structures such as bladder, bowel, perineal region, and bone marrow and consequently to high rates of acute toxicities and consequential late effects (17). IMRT has been demonstrated to provide a dosimetric advantage in terms of both target coverage and OARs avoidance compared to 3D-conformal EBRT (18,19).…”

A tumor control probability model for anal squamous cell carcinoma

“…Thirteen publications incorporating 645 patients were identified, details of individual series are presented in Table 1 [27][28][29][30][31][32][33][34][35][36][37][38].…”