Intensity-Modulated Radiation Therapy for Anal Malignancies: A Preliminary Toxicity and Disease Outcomes Analysis

Pepek, Joseph M.; Willett, Christopher G.; Wu, Qian; Yoo, Sua; Clough, Robert; Czito, Brian G.

doi:10.1016/j.ijrobp.2009.09.046

Cited by 95 publications

(54 citation statements)

References 25 publications

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“…It therefore seems that the more conformal IMRT technique and the higher total dose did not result in a reduction in inguinal recurrence as compared with conventional irradiation. Some recent retrospective studies do suggest, however, that IMRT is potentially more effective than conventional irradiation [9][10][11]24]. Two-year LRC, OS and CFS vary from 83.6% to 95.0%, 86.9% to 100% and 81.2% to 91.0%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcome in patients treated with simultaneous integrated boost – intensity modulated radiation therapy (SIB-IMRT) with and without concurrent chemotherapy for squamous cell carcinoma of the anal canal

et al. 2016

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Background and purpose To retrospectively evaluate locoregional control (LRC), survival and toxicity in anal cancer patients treated with simultaneous integrated boost -intensity modulated radiation therapy (SIB-IMRT) ± concurrent chemotherapy. Methods and materials Patients with squamous cell anal carcinoma stage T1(!1 cm)-4, N0-3, M0-1 were included. All patients were treated with SIB-IMRT to a total dose of 59.4 Gy delivered to the primary tumor and macroscopically involved lymph nodes and 49.5 Gy to elective lymph node areas. If macroscopic residual tumor was still present in the fifth week of irradiation, a sequential boost of 5.4 Gy was given. Concurrent chemotherapy was administered in locally advanced cases. Acute and late toxicity were scored. Results One hundred and six patients treated consecutively between April 2006 and December 2012 were included. Eighty-seven (82.1%) patients received concurrent chemotherapy. The median follow-up was 47 months (range 2-104 months). Ninety-eight patients reached a clinical complete response (92.5%). Four-year actuarial LRC rate, overall survival and colostomy-free survival were 79%, 77% and 77%, respectively. Acute grade !3 toxicity occurred in 67.9% of the patients. Late grade 3 toxicity was seen in 16 patients (15.1%). Conclusions SIB-IMRT ± concurrent chemotherapy for anal cancer was effective with acceptable toxicity.

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Section: Discussionmentioning

confidence: 99%

“…This technique has been demonstrated and analyzed for anal carcinoma in a number of retrospective studies and is claimed to be superior to conventional radiation techniques [9][10][11].…”

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confidence: 99%

Clinical outcome in patients treated with simultaneous integrated boost – intensity modulated radiation therapy (SIB-IMRT) with and without concurrent chemotherapy for squamous cell carcinoma of the anal canal

et al. 2016

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“…Thus, alternative radiation treatment schedules tailored to reduce toxicities without compromise of disease control have been investigated, including the delivery of lower dose radiotherapy [12], continuous vs. split course treatments [13], brachytherapy [14], and the introduction of Intensity-modulated radiation therapy (IMRT) as an alternative to the conventional conformal radiation therapy (CRT) [15,16]. The current clinical practice guidelines for anal cancer recommend radiation doses of at least 45-50 Gray (Gy) with boost doses between 15 and 20 Gy , thus the study and management of late toxicities is clearly pertinent [11].…”

Section: Introduction Backgroundmentioning

confidence: 99%

Systematic review of the quality of life issues associated with anal cancer and its treatment with radiochemotherapy

Sodergren

Vassiliou

Dennis

et al. 2015

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PurposeRadiochemotherapy is the standard of care for the treatment of anal carcinoma achieving good loco-regional control and sphincter preservation. This approach is however associated with acute and late toxicities including haematological, skin, bowel function and genito-urinary complications. This paper systematically reviews studies addressing the quality of life (QoL) implications of anal cancer and radiochemotherapy. The paper also evaluates how QoL is assessed in anal cancer. MethodsMedline, EMBASE, CINAHL, PsycInfo, Web of Science and the Cochrane Library were searched for publications (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) reporting the effects on patients of anal cancer and radiochemotherapy. ResultsOf the 152 papers reporting treatment-related effects on patients, only 11 provided a formal assessment of QoL. In the absence of an anal cancer specific measure, QoL was assessed using generic cancer instruments such as the core EORTC quality of life questionnaire (EORTC QLQ-C30) or colorectal cancer tools such as the EORTC QLQ-CR29. Bowel function, particularly diarrhoea, and sexual problems were the most commonly reported QoL concerns. The review of QoL issues of anal cancer patients treated with radiochemotherapy is limited by the QoL assessment measures used. It is argued that certain treatment-related toxicities, for example skin-induced radiation problems are overlooked or inadequately represented in existing measures. ConclusionsThis review emphasises the need to develop an anal cancer specific QoL measure and to incorporate QoL as an outcome of future trials in anal cancer. The results of this review are informative to clinicians and patients in terms of treatment decision making.

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“…As a result, a large portion of the small bowel, bladder, bone marrow and skin are exposed to radiation. Several retrospective reports have shown that IMRT yields favorable GI, genitourinary, skin and hematologic toxicity profiles compared with 3D conformal radiotherapy [8][9][10][11][12][13][14]. This prompted the RTOG 0529 Phase II trial, which prospectively investigated of the use of 'dose-painted' IMRT for anal canal cancers, whereby different dose levels were delivered simultaneously to different CTV structures, depending on the tumor, node, metastasis stage and gross disease dimensions [15].…”

Section: Intensity-modulated Radiation Therapymentioning

confidence: 99%

Intensity-modulated radiation therapy for patients with rectal cancer

2014

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Intensity-Modulated Radiation Therapy for Anal Malignancies: A Preliminary Toxicity and Disease Outcomes Analysis

Cited by 95 publications

References 25 publications

Clinical outcome in patients treated with simultaneous integrated boost – intensity modulated radiation therapy (SIB-IMRT) with and without concurrent chemotherapy for squamous cell carcinoma of the anal canal

Clinical outcome in patients treated with simultaneous integrated boost – intensity modulated radiation therapy (SIB-IMRT) with and without concurrent chemotherapy for squamous cell carcinoma of the anal canal

Systematic review of the quality of life issues associated with anal cancer and its treatment with radiochemotherapy

Intensity-modulated radiation therapy for patients with rectal cancer

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