Intensified intensity-modulated radiotherapy in anal cancer with prevalent HPV p16 positivity

Belgioia, Liliana; Vagge, Stefano; Agnese, D.; Garelli, S.; Murialdo, Roberto; Fornarini, Giuseppe; Chiara, Silvana; Gallo, Fabio; Bacigalupo, Almalina; Corvò, Renzo

doi:10.3748/wjg.v21.i37.10688

Cited by 11 publications

(10 citation statements)

References 31 publications

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“…Chemotherapy regimens are normally followed by intensity modulated RT (IMRT) at a radical dose of 60 Gy in 30 fractions to surgical bed as happened in our patient . Helical tomotherapy allows the delivery of higher doses to target volumes along with better sparing of normal tissues and to perform daily IGRT permitting us to correct any possible setup errors at every application, increasing the precision of the treatment and reducing interfraction changes . In our case, the patient had a disease‐free survival and was symptom‐free for 19‐months after first EBRT.…”

Section: Discussionmentioning

confidence: 71%

Reirradiation of pulmonary artery intimal sarcoma: A case report

Chiola

Belgioia

Vaccara

et al. 2019

Clinical Case Reports

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Section: Discussionmentioning

confidence: 71%

Reirradiation of pulmonary artery intimal sarcoma: A case report

Chiola

Belgioia

Vaccara

et al. 2019

Clinical Case Reports

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“…The numerous series published used a wide range of CTV to PTV margins ranging from 5 mm to 15 mm [31], [32], [33], [34] but none of the published literature suggests individualised margins for different targets. This widespread variation suggests there remains uncertainty regarding the correct margin and the need for studies similar to our own.…”

Section: Discussionmentioning

confidence: 99%

Quantifying target-specific motion in anal cancer patients treated with intensity modulated radiotherapy (IMRT)

Durrant

Robinson

Hawkins

et al. 2016

Radiotherapy and Oncology

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Background and purposeIntensity modulated radiotherapy requires all target areas to be treated by a single radiotherapy plan. In anal cancer, the pelvic nodes, inguinal nodes and primary tumour represent three different targets. We aim to calculate target-specific motion in anal cancer radiotherapy, when delivered using a single pelvic online auto-match.Materials and methodsTwenty consecutive patients treated using IMRT at a single institution were studied. CBCTs were retrospectively re-matched around the inguinal nodes and primary tumour. Match values were recorded relative to origin, defined as pelvic CBCT auto-match. Systematic and random errors were quantified to determine target-specific motion and suggested margins calculated using van Herk formulae.ResultsThe suggested margins to cover the independent motion of the inguinal and anal targets for LR, CC and AP set up around the inguinal nodes were 1.5 mm, 2.7 mm and 2.8 mm; and the primary tumour were, 4.6 mm, 8.9 mm and 5.2 mm respectively.ConclusionsTarget-specific set up will likely result in reduced treatment volumes and as such reduced toxicity. This is the first time a relationship has been described between pelvic bones, inguinal nodes and primary tumour. The PLATO study will prospectively assess the toxicity and outcomes of this target-specific margins strategy.

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“…IMRT, which modulates radiation intensity in a given field often with nine or more fields, allows delivery of more conformal dose, facilitating coverage of the clinical target with reduction of dose to surrounding normal organs at risk, possibly resulting in fewer treatment breaks and decreased overall treatment time [ 53 , 68 ]. Various retrospective and small prospective series demonstrated reductions in gastrointestinal and skin toxicity with the use of IMRT relative to the MMC arm of RTOG 98-11, where patients were treated with 2-dimensional or 3-dimensional conformal radiotherapy (3DCRT, Figure 1 ) [ 79 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 ]. Several institutional series compared patients treated with 3DCRT and IMRT and also demonstrated improved dermatologic and gastrointestinal toxicities, with comparable disease-specific outcomes compared to the MMC arm of RTOG 98-11 [ 85 , 93 , 94 , 95 , 96 , 97 , 98 ].…”

Section: Intensity-modulated Radiation Therapy: Rtog 05-29mentioning

confidence: 99%

Evolution of the Role of Radiotherapy for Anal Cancer

Dee

Byrne

2021

Cancers

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Prior to the 1980s, the primary management of localized anal cancer was surgical resection. Dr. Norman Nigro and colleagues introduced neoadjuvant chemoradiotherapy prior to abdominoperineal resection. Chemoradiotherapy 5-fluorouracil and mitomycin C afforded patients complete pathologic response and obviated the need for upfront surgery. More recent studies have attempted to alter or exclude chemotherapy used in the Nigro regimen to mitigate toxicity, often with worse outcomes. Reductions in acute adverse effects have been associated with marked advancements in radiotherapy delivery using intensity-modulated radiation therapy (IMRT) and image-guidance radiation delivery, resulting in increased tolerance to greater radiation doses. Ongoing trials are attempting to improve IMRT-based treatment of locally advanced disease with efforts to increase personalized treatment. Studies are also examining the role of newer treatment modalities such as proton therapy in treating anal cancer. Here we review the evolution of radiotherapy for anal cancer and describe recent advances. We also elaborate on radiotherapy’s role in locally persistent or recurrent anal cancer.

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Intensified intensity-modulated radiotherapy in anal cancer with prevalent HPV p16 positivity

Abstract: In our experience, intensified SIB-IMRT with chemotherapy is very feasible in clinical practice, with excellent results in terms of overall survival and local control.

Cited by 11 publications

References 31 publications

Reirradiation of pulmonary artery intimal sarcoma: A case report

Reirradiation of pulmonary artery intimal sarcoma: A case report

Quantifying target-specific motion in anal cancer patients treated with intensity modulated radiotherapy (IMRT)

Evolution of the Role of Radiotherapy for Anal Cancer

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