Prospective evaluation of acute toxicity and patient reported outcomes in anal cancer and plan optimization

Kronborg, C.; Serup-Hansen, Eva; Lefèvre, Anna Cecilie; Wilken, Eva E.; Petersen, Jørgen B. B.; Hansen, J. Lundsgaard; Schouboe, A.; Nyvang, Lars; Spindler, Karen‐Lise Garm

doi:10.1016/j.radonc.2018.06.006

Cited by 22 publications

(21 citation statements)

References 24 publications

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“…Most tumors were P16 positive (82%). Patients were treated as previously presented [ 9 , 13 ]. Radiotherapy comprised dose levels of 64Gy/32 fractions ( n = 58), 60Gy/30 fractions ( n = 17) and 54-50Gy/27-25 fractions ( n = 12), one patient received 48Gy/30 fractions.…”

Section: Resultsmentioning

confidence: 99%

“…Patients with newly diagnosed SCCA at Department of Oncology, Aarhus University Hospital, Denmark, were included in the prospective clinical data and biobank collection study “Plan-A”, Ethical Committee no. 1-10-72-79-16, as described previously [ 9 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

“…Localized SCCA is treated with high-dose chemo-radiotherapy (CRT) leading to an excellent local control of approximately 87 percent [ 6 ]. However, CRT implies a high risk of acute and/or late side effects, with potential negative impact on quality of life [ 7 , 8 , 9 , 10 ]. Development of distant metastases occurs in approximately 10 percent of the patients after primary treatment and holds a poor prognosis with a median survival of 12–20 months [ 2 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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The Clinical Value of Measuring Circulating HPV DNA during Chemo-Radiotherapy in Squamous Cell Carcinoma of the Anus

Lefèvre

Pallisgaard

Kronborg

et al. 2021

Cancers

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Background and purpose: Circulating tumor DNA (ctDNA) is investigated in various cancers. In squamous cell carcinoma of the anus (SCCA) infection with human papilloma virus (HPV) is found in around 90% of cases and here, plasma HPV (pHPV) can be used as ctDNA. Preliminary data have proved the ability to detect pHPV16 and -18 in SCCA. We have developed a highly sensitive method for measurement of six relevant pHPV subtypes, to investigate the elimination pattern of pHPV during chemo-radiotherapy (CRT) for SCCA and its clinical value. Material and methods: Patients treated at Aarhus University Hospital from 2016–2020 were included. P16 status in the primary biopsy was measured and 82% of patients had P16 positive tumor. Blood samples were collected prior to treatment (PT), mid treatment (MT), end of therapy (EOT), and during follow-up (FU). An in-house multiplex digital droplet PCR method measured pHPV subtypes 16, 18, 31, 33, 51, 58. Results: Samples from 88 patients were drawn PT (n = 73), MT (n = 72), EOT (n = 64) and during FU (n = 41). Plasma HPV was detectable in 52 patients and PT pHPV levels correlated to tumor stages. Three elimination patterns were observed during CRT with correlation to outcome: fast responders with no local or distant failures (0/12); slow responders with high risk of local failures (4/20), no distant failures; persistent molecular responders with high risk of distant failures (4/13), but no local failures, p < 0.01. Conclusion: During CRT, pHPV can divide patients with SCCA into three groups with significantly different risk of failure. The use of pHPV can potentially assist in clinical treatment decision.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Clinical Value of Measuring Circulating HPV DNA during Chemo-Radiotherapy in Squamous Cell Carcinoma of the Anus

Lefèvre

Pallisgaard

Kronborg

et al. 2021

Cancers

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“…The decreased side-effect profile may permit safe multimodal therapy, including concurrent or sequential surgery and chemotherapy. As was shown with VMAT over IMRT, PBT may similarly shorten treatment time via fewer treatment breaks due to reduced acute toxicity to small bowel and bone marrow (58,70,71). Reduction in secondary malignancy has also been suggested by benchmark analyses in other cancers (72)(73)(74).…”

Section: Future Directionsmentioning

confidence: 86%

“…In the future, advances in pencil-beam scanning and IMPT may further improve dosimetric advantages of protons (78). Early data show promising reductions to small bowel and bone marrow, suggesting that GI and hematologic toxicity may improve (58,59,61,62). Modeling by Meier et al shows reduction in grade 3+ hematologic toxicity with IMPT, as implied by other treatment-planning studies (62,63).…”

Section: Future Directionsmentioning

confidence: 99%

Proton beam radiotherapy for anal and rectal cancers

Vaios¹,

Wo²

2020

J Gastrointest Oncol

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This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (1). Eligibility criteria included published work evaluating treatment plans and clinical outcomes of proton radiation therapy for anal or rectal cancer. Sources of information for this review included PubMed and EMBASE, those found in references from the major articles identified, and articles known to the authors. The searches were conducted to identify any and all articles addressing clinical outcomes of proton radiotherapy for anal or rectal neoplasms in adults with the following headings: protons, proton radiation therapy, proton beam therapy (PBT), pencil-beam, intensitymodulated PBT (IMPT), anal, anal cancer, rectal, or rectal cancer. Due to the limited amount of overall data, search terms were not restricted by publication year or number of patients. Searches were completed by October 4th, 2018.Based on the initial searches, a total of 575 articles and abstracts were identified. Care was taken to ensure that the inclusion criteria were sufficiently broad. To avoid missing potentially relevant publications, sources were excluded by individual screening rather than the initial database search. After duplicates were removed and the papers were independently screened for the described criteria, a further 528 studies were excluded. Articles without specific assessment of dosimetry or clinically relevant outcomes (e.g., survival, toxicity) of proton radiation therapy (RT) for anorectal cancers in adults were excluded. Of the 47 publications remaining, 17 review articles and 30 original investigations (15 published articles, 11 abstracts, and 4 case

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