Interstitial high-dose rate brachytherapy as boost for anal canal cancer

Falk, Alexander Tuan; Claren, Audrey; Bénézery, Karen; François, Ετιεννε; Gautier, Mathieu; Gérard, Jean-Pierre; Hannoun‐Lévi, Jean‐Michel

doi:10.1186/s13014-014-0240-4

Cited by 22 publications

(26 citation statements)

References 29 publications

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“…In our analysis, we chose a relatively high threshold of 40 patients in order to analyze only numerically representative series and therefore, with more reliable results due to higher statistical homogeneity. However, some interesting series [ 33 , 34 , 35 ] with smaller sample size (< 40 patients receiving BRT boost) have been published in the last decades. Saarilahti et al .…”

Section: Discussionmentioning

confidence: 99%

Brachytherapy boost after chemoradiation in anal cancer: a systematic review

Frakulli

Buwenge

Cammelli

et al. 2018

jcb

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Radio-chemotherapy (RCT) is the primary treatment of anal cancer (AC). However, the role and the optimal total dose of a radiation boost is still unclear. No randomized controlled trials nor systematic reviews have been performed to analyze the efficacy of brachytherapy (BRT) as boost in AC. Therefore, we performed this systematic review based on PRISMA methodology to establish the role of BRT boost in AC.A systematic search of the bibliographic databases: PubMed, Scopus, and Cochrane library from the earliest possible date through January 31, 2018 was performed. At least one of the following outcomes: local control (LC), loco-regional control (LRC), overall survival (OS), disease-free survival (DFS), or colostomy-free survival (CFS) had to be present for inclusion in this systematic review in patients receiving a BRT boost. Data about toxicity and sphincter function were also included.Ten articles fulfilled the inclusion criteria. All the studies had retrospective study design. All studies were classified to provide a level of evidence graded as 3 according to SIGN classification. Median 5-year LC/LRC, CFS, DFS, and OS were: 78.6% (range, 70.7-92.0%), 76.1% (range, 61.4-86.4%), 75.8% (range, 65.9-85.7%), and 69.4% (63.4-82.0%), respectively. The reported toxicities were acceptable.RCT is the treatment cornerstone in AC. High-level evidences from studies on BRT boost in AC are lacking. Further studies should investigate: efficacy of BRT boost in comparison to no boost and to external beam boost, patients who can benefit from this treatment intensification, and optimal radiation dose.

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Section: Discussionmentioning

confidence: 99%

Brachytherapy boost after chemoradiation in anal cancer: a systematic review

Frakulli

Buwenge

Cammelli

et al. 2018

jcb

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“…Moreover, particularly with IMRT technique, we delivered a higher EBRT dose compared to other BT boost experiences published. Moreover, other authors reported a protocol that established BT after 4-6 weeks [ 18 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…In another analysis published in the same year by Falk et al . [ 18 ], these parameters were 0.58 and 0.38, respectively. Major et al .…”

Section: Discussionmentioning

confidence: 99%

MITHRA – multiparametric MR/CT image adapted brachytherapy (MR/CT-IABT) in anal canal cancer: a feasibility study

Tagliaferri

Manfrida

Barbaro

et al. 2015

jcb

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PurposeThe aim of this study is to test a novel multiparametric imaging guided procedure for high-dose-rate brachytherapy in anal canal cancer, in order to evaluate the feasibility and safety.Material and methodsFor this analysis, we considered all consecutive patients who underwent magnetic resonance/computed tomography image adapted brachytherapy (MR/CT-IABT) treated from February 2012 to July 2014. To conduct this project, we formed a working group that established the procedure and identified the indicators and benchmarks to evaluate the feasibility and safety. We considered the procedure acceptable if 90% of the indicators were consistent with the benchmarks. Magnetic resonance imaging with contrast and diffusion weighted imaging were performed with an MRI-compatible dummy applicator in the anus to define the position of the clinical target volume disease and biological information. A pre-implantation treatment planning was created in order to get information on the optimal position of the needles. Afterwards, the patient underwent a simulation CT and the definite post-implantation treatment planning was created.ResultsWe treated 11 patients (4 men and 7 women) with MR/CT-IABT and we performed a total of 13 procedures. The analysis of indicators for procedure evaluation showed that all indicators were in agreement with the benchmark. The dosimetric analysis resulted in a median of V200, V150, V100, V90, V85, respectively of 24.6%, 53.4%, 93.5%, 97.6%, and 98.7%. The median coverage index (CI) was 0.94, the median dose homogeneity index (DHI) was 0.43, the median dose non-uniformity ratio (DNR) resulted 0.56, the median overdose volume index (ODI) was 0.27. We observed no episodes of common severe acute toxicities.ConclusionsBrachytherapy is a possible option in anal cancer radiotherapy to perform the boost to complete external beam radiotherapy (EBRT). Magnetic resonance can also have biological advantages compared to the US. Our results suggest that the multiparametric MR/CT-IABT for anal cancer is feasible and safe. This new approach paves the way to prospective comparison studies between MRI and ultrasound-guided brachytherapy (USBT) in anal canal cancer.

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“…Fistulae including recto-vaginal, rectovesical, anal, or rectal fistula occur in 0.7-22.2% of patients [75,105,[108][109][110][111][112]. Other reported adverse symptoms included perineal/anal/rectal pain, necrosis, colonic obstruction, small bowel obstruction, perforation, telangiectasia, constipation, abdominal pain, tenesmus, enteritis, rectal mucus, and perianal numbness [36,66,84,107,[113][114][115][116][117][118].…”

Section: Other Gi Toxicitiesmentioning

confidence: 99%

Late gastrointestinal toxicity after radiotherapy for anal cancer: a systematic literature review

et al. 2018

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Introduction: There is a paucity of data on incidence and mechanisms of long-term gastrointestinal consequences after chemoradiotherapy for anal cancer. Most of the adverse effects reported were based on traditional external beam radiotherapy whilst only short-term follow-ups have been available for intensity-modulated radiotherapy, and there is lack of knowledge about consequences of doseescalation radiotherapy. Method: A systematic literature review. Results: Two thousand nine hundred and eighty-five titles (excluding duplicates) were identified through the search; 130 articles were included in this review. The overall incidence of late gastrointestinal toxicity was reported to be 7-64.5%, with Grade 3 and above (classified as severe) up to 33.3%. The most commonly reported late toxicities were fecal incontinence (up to 44%), diarrhea (up to 26.7%), and ulceration (up to 22.6%). Diarrhea, fecal incontinence and buttock pain were associated with lower scores in radiotherapy specific quality of life scales (QLQ-CR29, QLQ-C30, and QLQ-CR38) compared to healthy controls. Intensity-modulated radiation therapy appears to reduce late toxicity. Conclusion: Late gastrointestinal toxicities are common with severe toxicity seen in one-third of the patients. These symptoms significantly impact on patients' quality of life. Prospective studies with control groups are needed to elucidate long-term toxicity.

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Interstitial high-dose rate brachytherapy as boost for anal canal cancer

Cited by 22 publications

References 29 publications

Brachytherapy boost after chemoradiation in anal cancer: a systematic review

Brachytherapy boost after chemoradiation in anal cancer: a systematic review

MITHRA – multiparametric MR/CT image adapted brachytherapy (MR/CT-IABT) in anal canal cancer: a feasibility study

Late gastrointestinal toxicity after radiotherapy for anal cancer: a systematic literature review

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