30 Gy may be an adequate dose in patients with anal cancer treated with excisional biopsy followed by combined-modality therapy

Hu, Kenneth; Minsky, Bruce D.; Cohen, Alfred M.; Kelsen, David P.; Guillem, José G.; Paty, Philip; Quan, Stuart H. Q.

doi:10.1002/(sici)1096-9098(199902)70:2<71::aid-jso2>3.0.co;2-y

Cited by 49 publications

(22 citation statements)

References 27 publications

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“…There have been no locoregional failures within the 30 Gy treatment volume without failure either locally in the 50 Gy volume and/or disseminated disease. This is consistent with the hypothesis that 30 Gy is adequate for microscopic disease, which is further supported by a recent series in which 30 Gy seemed to be an effective dose in patients with anal cancer treated by excisional biopsy followed by CRT (Hu et al, 1999). However, there is evidence that 30 Gy is inadequate for control of macroscopic disease (Myerson et al, 1995).…”

Section: Discussionsupporting

confidence: 86%

Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost

Melcher

Sebag‐Montefiore

2003

Br J Cancer

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Chemoradiotherapy (CRT) is now widely accepted as the primary treatment modality for squamous cell cancer of the anus. While randomised trials have clearly shown CRT to be more effective than radiotherapy alone, there remains uncertainty over the optimal integration of chemotherapy and radiation. We describe a series of 50 patients treated by a site specialist gastrointestinal nonsurgical oncologist with CRT at a single UK centre. Chemotherapy comprised mitomycin C (MMC) (day 1) and 5-fluorouracil (5-FU) (days 1 -4, and 29 -32), concurrent with 50 Gy in 25 fractions radiation, using a two-phase shrinking field technique. A radiation boost was not planned. At a median follow-up of 48 months, 11 (22%) of the patients have failed locally, of which three have been surgically salvaged. Nine (18%) have died of anal cancer. These results are comparable with those from large randomised studies, and suggest that a two-phase shrinking field radiotherapy technique with no boost, concurrent with MMC/5-FU chemotherapy, is an effective regimen for this disease. The CRT regimen described here provides the basis for the 'control arm' of the current UK-randomised CRT trial in anal cancer (ACT2).

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Section: Discussionsupporting

confidence: 86%

Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost

Melcher

Sebag‐Montefiore

2003

Br J Cancer

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“…Radiation doses used in this study were higher than those used previously, reaching 67 Gray (Gy) total [33]. Researchers from Memorial Sloan Kettering Cancer Center suggested that a select group of patients with small lesions were candidates for initial excisional biopsy followed by postoperative radiation with a limited dose of 30 Gy, this being adequate for disease control [40].…”

Section: Radiation Treatment As a Sole Modality External Beam Radiatimentioning

confidence: 88%

“…It is probably true that a dose of little more than 30 Gy is adequate to gain control of an area where there is only risk of microscopic tumor burden [40]. There are, however, data that suggest a dose-response relationship for control of gross tumor burden [56,[71][72][73].…”

Section: What Is the Optimal Radiation Treatment Dose?mentioning

confidence: 99%

Carcinoma of the Anus: Strategies in Management

2002

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The management of anal cancer underwent an interesting transformation over the last two decades. Prior to this period, the standard definitive treatment for carcinoma of the anal canal was abdominal-perineal resection, which necessitated a permanent colostomy. The organ preservation concept appeared following the discovery of a high complete response rate from preoperative combined chemoradiation prior to abdominal-perineal resection.The organ preservation method of treatment rapidly gained popularity and ultimately saved a large number of patients from undergoing abdominal-perineal resection and colostomy. Chemoradiation treatment itself subsequently went through an evolutionary process. Several studies have sought to define the optimal chemotherapeutic regimen as well as radiation treatment dose and fractionation. Ongoing studies attempt to define an optimal treatment regimen that yields a higher cure rate while minimizing toxicity. We review the etiology, epidemiology, and treatment regimens for anal cancer.

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“…Whereas some groups postulate total doses as low as 30 Gy [9], others recommend total doses of ≥ 54 Gy for a scheme consisting of external beam treatment only [4]. A majority of groups uses around 40-50 Gy with varying protocols for additional brachytherapy boost treatment [1,2,8,14].…”

Section: Discussionmentioning

confidence: 99%

Intracavitary Afterloading Boost in Anal Canal Carcinoma Results, Function and Quality of Life

et al. 2001

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30 Gy may be an adequate dose in patients with anal cancer treated with excisional biopsy followed by combined-modality therapy

Cited by 49 publications

References 27 publications

Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost

Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost

Carcinoma of the Anus: Strategies in Management

Intracavitary Afterloading Boost in Anal Canal Carcinoma Results, Function and Quality of Life

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