Long-term Patterns of Failure and the Value of Blood Prognostic Markers in Anal Cancers Treated With Intensity-Modulated Radiation Therapy

Sia, Joseph; Wei, Mou; Agas, Ryan Anthony F.; Xie, Jing; Burns, Mark R.; Varghayee, Nahal; Chu, Julie; Heriot, Alexander; Leong, Trevor; Ngan, Samuel Y

doi:10.1016/j.clcc.2021.10.005

Cited by 3 publications

(6 citation statements)

References 31 publications

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“…There are limited reports from Australia using an exclusively VMAT technique. However, both Australian and international series employing fixed field IMRT have reported comparable 5 ‐year LRC and OS outcomes of 81%–84% and 76%, respectively, 5,10 similar to our results (Table 4).…”

Section: Discussionsupporting

confidence: 90%

“…We also achieved similar organ preservation rates compared to contemporary series (Table 4), which reported 5-year colostomyfree survival of between 74% and 89.3%. 5,10,12 Our series reported few local recurrences, and only 9% of patients underwent salvage APR. This is lower than the 25%-32.3% locoregional failure rate reported in the seminal ACT I and RTOG 98-11 randomised trials, 2,13 and also lower than the rates reported in many of the contemporary series employing IMRT, tomotherapy or VMAT (Table 4).…”

Section: Discussionmentioning

confidence: 66%

“…The toxicity profile of our treatment was excellent and also very comparable to Australian and international series (Table 5). Reported acute grade 3 gastrointestinal toxicities range between 6% and 21%, and acute grade 3+ genitourinary toxicities range from 0% to 1.9% 10,11 . Late toxicity reporting is heterogeneous in the available series (Table 6); however, we note that one Australian tertiary centre, reported a 10% late grade 2 GI toxicity, a grade 3 GI toxicity of 3% and a late grade 2 GU toxicity of 1%, with no grade 3 late GU toxicity 10 : these rates are also comparable to our results.…”

Section: Discussionmentioning

confidence: 87%

“…This is lower than the 25%-32.3% locoregional failure rate reported in the seminal ACT I and RTOG 98-11 randomised trials, 2,13 and also lower than the rates reported in many of the contemporary series employing IMRT, tomotherapy or VMAT (Table 4). 5,9,10,12 Statistical comparisons of these rates are not possible across series. The apparent reduction in local failures may be due to differences in patient, tumour and treatment factors, or may be due to the use of modern radiation therapy techniques.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term outcomes of definitive radiation with volumetric modulated arc therapy and concurrent chemotherapy for squamous cell carcinoma of the anus in a regional Australian cancer centre

Hsieh,

Shakespeare,

Winkley

et al. 2024

J Med Imag Rad Onc

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IntroductionConcurrent chemoradiotherapy is the standard of care in the curative intent treatment of squamous cell carcinoma (SCC) of the anus. Volumetric arc therapy (VMAT) is a highly conformal radiation therapy technique that has been implemented to reduce toxicity for these patients. However, there are few reports evaluating the long‐term outcomes of VMAT. Thus, we evaluated the survival and toxicity outcomes of anal cancer patients treated in our regional cancer centre undergoing curative intent chemoradiotherapy using VMAT and following the Australian EviQ guidelines.MethodsAll consecutive patients treated with the VMAT technique for curative‐intent definitive chemoradiotherapy for anal SCC at our institution from 2013 until 2022 were retrospectively reviewed for survival and toxicity outcomes. Kaplan–Meier estimates of locoregional control, distant metastasis‐free survival, disease‐free survival, anal cancer‐specific survival and overall survival were obtained.ResultsIn total, 44 patients were analysed. The median follow‐up was 48.9 months (Range 7.8–107). 97.7% of patients completed the prescribed radiation therapy and 88.6% chemotherapy. Five patients (11.4%) recurred. Four (9.1%) had isolated local failures, and one (2.3%) had an isolated distant failure. There were no regional nodal failures. The Kaplan–Meier estimates for locoregional control, distant metastasis‐free survival, disease‐free survival, anal cancer‐specific survival and overall survival were 90.3%, 97.7%, 88.1%, 97.1% and 87% at 3 years, and 90.3%, 97.7%, 88.1%, 93.0% and 72.3% at 5 years, respectively. Acute grade 3 genitourinary (GU), gastrointestinal (GI) and skin toxicities occurred in 2.2%, 6.8% and 13.6% of patients, respectively. There were no acute grade 4 toxicities. Late grade 2 GU and GI toxicities occurred in 6.8% and 11.3% of patients, respectively. There were no late grade 3 or 4 toxicities or treatment‐related deaths. The 5 ‐year colostomy‐free survival rate was 86.4%.ConclusionOutcomes for anal SCC after definitive chemoradiotherapy using VMAT in our regional cancer centre results in low rates of grade 3/4 toxicity, high rates of organ preservation and excellent survival outcomes.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Long‐term outcomes of definitive radiation with volumetric modulated arc therapy and concurrent chemotherapy for squamous cell carcinoma of the anus in a regional Australian cancer centre

Hsieh,

Shakespeare,

Winkley

et al. 2024

J Med Imag Rad Onc

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“…They are also associated with the immune response against tumors [79]. Investigations have indicated that CRC patients with high proportions of peripheral blood neutrophils showed a poorer response to radiotherapy than patients with low numbers of neutrophils [80]. This also applies to CRC tumor tissues [81, 82].…”

Section: Tumor-infiltrating Immune Cellsmentioning

confidence: 99%

Changes in Tumor Immune Microenvironment after Radiotherapy Resistance in Colorectal Cancer: A Narrative Review

Wang¹,

Yuan²,

gao³

et al. 2023

Oncol Res Treat

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Background: Colorectal cancer (CRC) is a common digestive tract malignancy with high incidence and mortality rates. Radiotherapy is the most common anti-tumor therapeutic regime and is frequently used for treating CRC, especially rectal cancer. However, radiotherapy can lead to tumor resistance to treatment. While previous research on radiotherapy resistance in CRC has mostly focused on the tumor itself, recent advances, especially the emergence of immunotherapy, have led to a greater emphasis on the immune microenvironment of the tumor. Summary: This review summarizes the recent literature on the role of the tumor immune microenvironment in CRC resistance to radiotherapy and provides new ideas for future anti-tumor treatment strategies. Key messages: The proportion of immunosuppressive cells is greater than the numbers of cells associated with immune activation, leading to an overall state of immunosuppression; Both the tumor and immunosuppressive cells secrete increased amounts of immunosuppressive regulatory factors, reduce the recognition and presentation of tumor antigens, inhibit immune cell’s antitumor effect, and offset the non-targeted antitumor effect of radiotherapy.

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Nordic anal cancer (NOAC) group consensus guidelines for risk-adapted delineation of the elective clinical target volume in anal cancer

Nilsson,

Undseth,

Albertsson

et al. 2023

Acta Oncologica

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Long-term Patterns of Failure and the Value of Blood Prognostic Markers in Anal Cancers Treated With Intensity-Modulated Radiation Therapy

Cited by 3 publications

References 31 publications

Long‐term outcomes of definitive radiation with volumetric modulated arc therapy and concurrent chemotherapy for squamous cell carcinoma of the anus in a regional Australian cancer centre

Long‐term outcomes of definitive radiation with volumetric modulated arc therapy and concurrent chemotherapy for squamous cell carcinoma of the anus in a regional Australian cancer centre

Changes in Tumor Immune Microenvironment after Radiotherapy Resistance in Colorectal Cancer: A Narrative Review

Nordic anal cancer (NOAC) group consensus guidelines for risk-adapted delineation of the elective clinical target volume in anal cancer

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