Intensity-modulated radiotherapy vs. conventional radiotherapy in the treatment of anal squamous cell carcinoma: A propensity score analysis

Dasgupta, Tina; Rothenstein, Diana; Chou, Joanne F.; Zhang, Zhigang; Wright, Jean L.; Saltz, Leonard B.; Temple, Larissa K.; Paty, Philip B.; Weiser, Martin R.; Guillem, José G.; Nash, Garrett M.; Goodman, Karyn A.

doi:10.1016/j.radonc.2013.03.012

Cited by 43 publications

(33 citation statements)

References 20 publications

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“…We found a lower risk of tumor-related ostomy placement among IMRT patients, which might be attributable in part to higher chemotherapy completion rates, given randomized data showing an improvement in colostomy-free survival with concurrent chemotherapy (27). Finally, we found no difference in survival outcomes after multivariable adjustment, consistent with prior data that have not demonstrated a large survival improvement for IMRT (6,7,25).…”

Section: Discussionsupporting

confidence: 88%

“…In anal cancer, adoption of IMRT has been encouraged by the substantial hematologic, gastrointestinal, and dermatologic toxicities of combined chemotherapy and radiation treatment. Retrospective studies comparing IMRT and conventional conformal radiation therapy (RT) have suggested decreased hospitalization and toxicity benefits (1,(3)(4)(5)(6)(7). A phase 2 trial (Radiation Therapy Oncology Group [RTOG] 0529) comparing dose-painted IMRT with a historical conventional radiation arm did not reach its primary endpoint of lower combined gastrointestinal and genitourinary toxicity, although the investigators did find improvements in grade 2þ hematologic toxicity and grade 3þ dermatologic or gastrointestinal toxicity (2).…”

Section: Introductionmentioning

confidence: 99%

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Intensity Modulated Radiation Therapy Versus Conventional Radiation for Anal Cancer in the Veterans Affairs System

Bryant

Huynh‐Le

Simpson

et al. 2018

International Journal of Radiation Oncology*Biology*Physics

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SummaryThe real-world effectiveness of intensity modulated radiation therapy in reducing acute toxicity during anal cancer treatment remains unclear. In a large sample of patients with anal cancer collected from the Veterans Affairs system, intensity modulated radiation therapy was associated with increased rates of timely and complete treatment delivery and lower rates of ostomy placement related to tumor recurrence or progression. Intensity modulated radiation therapy appears to give substantial short-and Purpose: Compared with conventional radiation therapy, intensity modulated radiation therapy (IMRT) may reduce acute toxicity from anal cancer treatment, potentially leading to improved long-term outcomes. We analyze the effect of IMRT on short-and long-term outcomes among a large sample of US veterans. Methods and Materials: From a national Veterans Affairs database, we identified 779 patients (n Z 403 conventional radiation therapy, n Z 376 IMRT) with locally advanced anal squamous cell carcinoma diagnosed between 2000 and 2015 and treated with concurrent chemoradiation therapy. Radiation treatment planning and dosimetric constraints were not standardized across patients. We analyzed the effect of IMRT on short-term outcomes (acute toxicity, treatment breaks, and incomplete chemotherapy) and long-term outcomes (survival and ostomy placement) in multivariable logistic regression, Fine-Gray, and frailty models, adjusting for potential confounders. Results: IMRT was associated with decreased radiation treatment breaks 5 days (odds ratio [OR] 0.58; 95% confidence interval [CI] 0.37-0.91; P Z .02), increased rates of receiving 2 cycles of mitomycin C chemotherapy (OR 2.04; 95% CI 1.22-3.45; P Z .007), increased rates of receiving 2 cycles of any chemotherapy (OR 3.45; 95% CI 1.82-6.25; P < .001), and decreased risk of ostomy related to tumor recurrence or progression (subdistribution hazard ratio 0.60; 95% CI 0.37-0.99; P Z .045). IMRT was not associated with a decrease in grade 3 to 4 hematologic toxicity (P Z .79), hospitalization for gastrointestinal toxicity (P Z .59), or cancer-specific survival (P Z 0.18). Conclusions: Among a large sample of US veterans with anal cancer, IMRT was associated with higher rates of receiving 2 chemotherapy cycles, decreased radiation treatment breaks, and decreased rates of ostomy placement. IMRT appears to offer substantial benefits over conventional radiation therapy for patients undergoing concurrent chemoradiation therapy for anal cancer. Ó

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Intensity Modulated Radiation Therapy Versus Conventional Radiation for Anal Cancer in the Veterans Affairs System

Bryant

Huynh‐Le

Simpson

et al. 2018

International Journal of Radiation Oncology*Biology*Physics

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“…None of our patients had treatment break because of acute gastrointestinal adverse effects, even if fifteen patients had a planned gap according to our local guidelines at that time, independently on the symptoms. The clinical outcomes in patients treated with conformal or IMRT techniques are similar as Dasgupta showed in her analysis of a large cohort of patients (16), confirming the new standard of radiation therapy delivery. Chuong et al (17) reported 2 years LRC, OS and DFS of 94.6, 100 and 82.6% respectively in patients treated with IMRT based chemoradiation, registering minimal toxicity.…”

Section: Discussionsupporting

confidence: 65%

Concurrent chemoradiation with volumetric modulated Arc therapy of patients treated for anal cancer—acute toxicity and treatment outcome

Yordanov

Cima

Richetti

et al. 2017

J. Gastrointest. Oncol.

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“…16,17 . This side effect decrease has been shown not to affect oncological outcomes as Dasgupta et al 18 observed, within a propensity score analysis, that LC is not compromised by the use of IMRT compared with standard techniques. All the aforementioned studies investigated the role of IMRT in anal cancer within a retrospective framework.…”

Section: Discussionmentioning

confidence: 84%

Volumetric modulated arc therapy (VMAT) in the combined modality treatment of anal cancer patients

Franco

Arcadipane

Ragona

et al. 2016

BJR

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Objective: To report clinical and dosimetric outcomes of a consecutive series of patients with anal cancer treated with volumetric-modulated arc therapy (VMAT) concomitant to chemotherapy (CT). Methods: A cohort of 39 patients underwent VMAT employing a schedule consisting of 50.4 Gy/28 fractions to the gross tumour volume (GTV) and 42 Gy/28 fractions to the elective nodal volumes for patients with cT2N0 disease. Patients with cT3-T4/N0-N3 tumours were prescribed 54 Gy/30 fractions to the GTV and 50.4 Gy/30 fractions to the gross nodal volumes if sized #3 cm or 54 Gy/30 fractions if . 3 cm. Elective nodal regions were given 45 Gy/30 fractions. CT was administered concurrently following Nigro's regimen. The primary end point was acute toxicity. Secondary end points were colostomy-free survival (CFS), disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS). Dosimetric data are also provided.Results: Median follow-up was 21 months. Maximum acute toxicities were: dermatologic-G3: 18%; gastrointestinal-G3: 5%; genitourinary-G3: 2%; anaemia-G2: 7%; leukopenia-G3: 28%; G4: 8%; neutropenia-G3: 13%; G4: 18%; thrombocytopenia-G3: 11%; and G4: 2%. The actuarial 2-year CFS was 77.9% [95% confidence interval (CI): 54-90.4%]. Actuarial 2-year OS and CSS were 85.2% (95% CI: 60.1-95.1%), while DFS was 75.1% (95% CI: 52.4.7-88.1%). Conclusion: Our clinical results support the use of VMAT as a safe and effective intensity-modulated radiotherapy (IMRT) option in the combined modality treatment of anal cancer, with consistent dosimetry, mild toxicity and promising sphincter preservation and survival rates. Advances in knowledge: IMRT is a standard of care for patients with anal cancer, and VMAT is a robust technical solution in this setting.

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Intensity-modulated radiotherapy vs. conventional radiotherapy in the treatment of anal squamous cell carcinoma: A propensity score analysis

Cited by 43 publications

References 20 publications

Intensity Modulated Radiation Therapy Versus Conventional Radiation for Anal Cancer in the Veterans Affairs System

Intensity Modulated Radiation Therapy Versus Conventional Radiation for Anal Cancer in the Veterans Affairs System

Concurrent chemoradiation with volumetric modulated Arc therapy of patients treated for anal cancer—acute toxicity and treatment outcome

Volumetric modulated arc therapy (VMAT) in the combined modality treatment of anal cancer patients

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