Outcomes of Squamous Cell Carcinoma Anal Canal treated with IMRT-VMAT–based Concurrent Chemoradiation: a Single Institutional Experience

Singh, Kaalindi; Sathyamurthy, Arvind; Ramireddy, Jeba Karunya; Ram, Thomas Samuel

doi:10.1007/s12029-020-00580-z

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Although concurrent MMC/5FU remains the standard of care 16 , our institution has favored using weekly low dose cisplatin and daily 5FU concurrent with radiation 15 . Although retrospective results are no substitute for a randomized trial to establish the standard of care, we are reassured that our outcomes are similar to smaller reports outlining outcomes after IMRT 10-14 .…”

Section: Discussionsupporting

confidence: 68%

“…Existing publications on IMRT-based CRT for SCCA are small and/or have limited follow-up. 10-14 Most include a radiation dose of 50-54 Gy and concurrent mitomycin-C (MMC)/5FU as a chemosensitizer. Our aims are to (1) report LRF, colostomy failure (CF), OS, and toxicity data for patients treated with IMRT-based CRT at our institution, (2) evaluate any potential impact of dose escalation (>54 Gy), and (3) evaluate any differences between MMC-based versus cisplatin-based concurrent chemotherapy regimens.…”

Section: Introductionmentioning

confidence: 99%

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Definitive Intensity-Modulated Chemoradiation for Anal Squamous Cell Carcinoma: Outcomes and Toxicity of 428 Patients Treated at a Single Institution

et al. 2022

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Background Although intensity-modulated radiation therapy (IMRT) is considered the standard of care for the treatment of squamous cell carcinoma of the anus (SCCA), few large series have reported oncologic outcomes and toxicities. In this retrospective report, we aim to describe outcomes and toxicities after IMRT-based chemoradiation (CRT) for the treatment of SCCA, evaluate the impact of dose escalation (>54 Gy), and compare concurrent fluoropyrimidine in combination with either mitomycin or with cisplatin as chemosensitizers. Methods Patients treated at The University of Texas MD Anderson Cancer Center between January 1, 2003 and December 31, 2018 with IMRT-based CRT were included. Median time to locoregional recurrence, time to colostomy, and overall survival were estimated using the Kaplan–Meier method. Results A total of 428 patients were included; median follow-up was 4.4 years. Three hundred and thirty-four patients (78.0%) were treated with concurrent cisplatin and fluoropyrimidine, and 160 (37.4%) with >54 Gy. Two- and 5-year freedom from locoregional failure, freedom from colostomy failure, and overall survival were 86.5% and 81.2%, respectively, 90.0% and 88.3%, respectively, and 93.6% and 85.8%, respectively. Neither dose escalation nor mitomycin-based concurrent chemotherapy resulted in improved outcomes. Mitomycin-based concurrent chemotherapy was associated with in approximately 2.5 times increased grade 3 or greater acute toxicity. Radiation dose >54 Gy was associated with approximately 2.6 times increased Grade 3 or greater chronic toxicity. Conclusions Our results suggest IMRT-based CRT with concurrent fluoropyrimidine and cisplatin is a safe and feasible option for patient with SCCA and may cause less acute toxicity. The role for radiation dose escalation is unclear and requires further study.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Definitive Intensity-Modulated Chemoradiation for Anal Squamous Cell Carcinoma: Outcomes and Toxicity of 428 Patients Treated at a Single Institution

et al. 2022

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“…With an estimated PFS of 83% at 5 years, this study provides long-term data on the risk of progression with the current standard of care treatment techniques. A recently published single institution series reported a limited median follow up of 7.5 months with 75% remaining disease free at that time (41). A similar study was published with a median follow-up of 26 months and a disease free survival of 86% (42).…”

Section: Discussionmentioning

confidence: 76%

Long term clinical outcomes and associated predictors of progression free survival in anal canal cancer

Ponce¹,

Erickson²,

Hall³

et al. 2022

J Gastrointest Oncol

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Background: Reports of long term clinical outcomes for patients with squamous cell carcinoma (SCC) of the anal canal treated with chemotherapy and intensity modulated radiation therapy (IMRT) are limited.Pre-treatment hematologic variables associated with outcomes remain understudied. We sought to report the long-term clinical outcomes of a cohort of patients treated with definitive chemoradiation (CRT) utilizing helical tomotherapy (HT) IMRT at a single tertiary referral center. We further sought to examine for any correlations between pre-treatment hematologic parameters and progression free survival (PFS).Methods: Data from patients with SCC of the anal canal treated with definitive CRT using HT IMRT from 2005 to 2017 were collected. Pre-treatment patient characteristics examined for correlations with PFS included: hemoglobin (Hgb) level, age, diabetes mellitus (DM) status, smoking status, neutropenia, thrombocytopenia, leukopenia, neutrophil/lymphocyte ratio, neutrophil/WBC ratio, lymphocyte/WBC ratio, sex, transplant status, HIV status, Karnofsky performance score, T-stage, and N-stage. Pre-treatment Hgb levels were recorded within two weeks prior to starting CRT. Clinical outcomes, including PFS, were described using the Kaplan-Meier estimator. A multivariable (MVA) Cox model of PFS evaluated the impact of pre-treatment Hgb and diabetes while adjusting for T-stage and age.Results: The median patient age was 57 years old (range: 26-87) and there were 39 females (63.9%) with the remaining patients identifying as males. Median patient follow up was 5.8 years. The PFS was 83% at 5 years. The median pre-treatment Hgb was 13 g/dL. On multivariable analysis (MVA), Hgb ≤10 g/dL (HR: 11.891, 95% CI: 2.649-53.391, P=0.001) and a diagnosis of diabetes mellitus (HR: 4.524, 95% CI:1.436-14.252, P=0.010) were both significantly associated with a worse PFS. These factors were independent of T-stage and age.Conclusions: Long-term clinical outcomes for patients with SCC of the anal canal treated with definitive CRT are presented. Pre-treatment hemoglobin of ≤10 g/dL and diabetes were both independently associated with worse PFS on MVA. This retrospective data supports further prospective study of the impact of hematologic markers and medical co-morbidities such as DM and their management on clinical outcomes for patients with SCC of the anal canal treated with curative-intent CRT.

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Anal Canal Squamous Cell Carcinoma Treated WTH Intensity Modulated Radiation Therapy Based Concurrent Chemoradiation–retrospective Analysis of Clinical Outcome and Toxicities

Sivanandan

Sajeed

et al. 2021

ijsr

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Purpose: This retrospective analysis is aimed to report the single institution experience from an Asian country utilizing Intensity Modulated Radiotherapy (IMRT) based Chemo radiation in Anal Canal Squamous Cell Carcinoma (ASCC) with an emphasis on efcacy, toxicity and disease and treatment-related variables associated with outcomes. Study was conduc Materials And Methods: ted in the department of Radiation Oncology at Regional Cancer Center, Thiruvananthapuram. All Patients with biopsy proven ASCC diagnosed between January 2014 and December 2018 and receiving curative intent IMRT were identied and follow up data till December 2020 was collected. Primary end point was Disease-free survival (DFS). Secondary end points were Overall Survival (OS), Colostomy-free survival (CFS) Loco regional Failure (LRF) and Toxicities. A total of 34 patients were analyzed during a median follow up of Results: 34 months. Twenty ve patients (73.5%) were in stage IIIB. Median overall treatment time was 36 days. The estimated two year DFS, OS and CFS were 79.4 %, 93.9 %and 97% respectively. Disease recurrence at any point on follow up occurred in ve patients (14.7%). Primary Tumor size of more than or equal to 5 cm and development of grade three anemia during RT was associated with inferior DFS in Univariate analysis. Patients taken less than two cycles of chemotherapy, there was a trend for inferior OS. Acute grade 3 or more dermatological toxicities was 44% and hematological toxicity was 35.3%. Radiotherapy break occurred in 38.2%of patients with a median of 5.5 days (range 2-13). Of the available patients chronic toxicities were reported for 40% and were of grade 2. IMRT is associated with favorable toxicity rates and excellent Conclusion: long-term efcacy in Asian population also where patients are presenting in an advanced stage. Reducing the total treatment time by SIB technique may improve the clinical outcome.

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Outcomes of Squamous Cell Carcinoma Anal Canal treated with IMRT-VMAT–based Concurrent Chemoradiation: a Single Institutional Experience

Cited by 3 publications

References 12 publications

Definitive Intensity-Modulated Chemoradiation for Anal Squamous Cell Carcinoma: Outcomes and Toxicity of 428 Patients Treated at a Single Institution

Definitive Intensity-Modulated Chemoradiation for Anal Squamous Cell Carcinoma: Outcomes and Toxicity of 428 Patients Treated at a Single Institution

Long term clinical outcomes and associated predictors of progression free survival in anal canal cancer

Anal Canal Squamous Cell Carcinoma Treated WTH Intensity Modulated Radiation Therapy Based Concurrent Chemoradiation–retrospective Analysis of Clinical Outcome and Toxicities

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