Chemoradiotherapy in patients with anal cancer: Impact of length of unplanned treatment interruption on outcome

Meyer, Andreas; Eissen, J. Meier zu; Karstens, Johann H.; Bremer, Michael

doi:10.1080/02841860600726729

Cited by 26 publications

(27 citation statements)

References 23 publications

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“…In contrast, some of the studies showed no association between the length of treatment interruption and poor local control or diminished survival. [3334] An update of RTOG 92-08 phase II trial showed that 5-year estimates of DFS and CFS in patients treated on the mandatory treatment break arm were lower than reported on RTOG 87-04 while DFS and CFS in the no mandatory treatment break cohort of RTOG 92-08 were comparable to other reported series. It further concluded that treatment breaks should be kept to a minimum.…”

Section: Intensity Modulated Radiation Therapymentioning

confidence: 76%

Sphincter preservation in anal cancer: A brief review

Khosla

Kumar

Kapoor

et al. 2013

Saudi J Gastroenterol

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Management of anal cancer is a challenge. The goal of treatment is to eradicate tumor without sacrificing the anal sphincters. The idea of organ preservation emerged following the discovery of a high complete response rate from preoperative combined chemoradiation (CRT) prior to abdominoperineal resection. CRT is widely accepted as the standard therapy for treating anal squamous cell cancer. The combination of external beam radiotherapy with interstitial brachytherapy increases the dose to the tumor volume and decreases dose to normal tissues. The current goal is to avoid colostomy, and surgery has become a salvage or secondary therapy. In this article, we review the non-surgical management of anal cancer with special emphasis on CRT, role of intensity modulated radiation therapy and brachytherapy.

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Section: Intensity Modulated Radiation Therapymentioning

confidence: 76%

Sphincter preservation in anal cancer: A brief review

Khosla

Kumar

Kapoor

et al. 2013

Saudi J Gastroenterol

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“…References : Vuong [10], Meyer [11], Graf [16], Tanum [26], Widder [18], Doci [23], Ceresoli [31], Weber [15], Ferrigno [19], Mai [24], Grabenbauer [32], Constantinou [17]…”

Section: Resultsmentioning

confidence: 99%

“…In the last few years some institutions have started to omit the mandatory split completely for high-dose RT above 50 Gy in anal cancer [8-11]. Feasibility data have been inconsistent and the recent RTOG 92-08 trial which evaluated 59.4 Gy without mandatory split demonstrated comparable or favourable survival and tumor control compared with split-regimen [8,10,11]. Currently there is no standard in terms of mandatory split and it is unclear whether continuous CRT should be recommended as standard of care for the treatment of anal cancer.…”

Section: Introductionmentioning

confidence: 99%

Chemo-radiation with or without mandatory split in anal carcinoma: experiences of two institutions and review of the literature

et al. 2010

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BackgroundThe split-course schedule of chemo-radiation for anal cancer is controversial.MethodsEighty-four patients with invasive anal cancer treated with definitive external beam radiotherapy (RT) with a mandatory split of 12 days (52 patients, Montreal, Canada) or without an intended split (32 patients, Zurich, Switzerland) were reviewed. Total RT doses were 52 Gy (Montreal) or 59.4 Gy (Zurich) given concurrently with 5-FU/MMC.ResultsAfter a mean follow-up of 40 ± 27 months, overall survival and local tumor control at 5 years were 57% and 78% (Zurich) compared to 67% and 82% (Montreal), respectively. Split duration of patients with or without local relapse was 15 ± 7 d vs. 14 ± 7 d (Montreal, NS) and 11 ± 11 d vs. 5 ± 7 d (Zurich; P < 0.001). Patients from Zurich with prolonged treatment interruption (≥ 7 d) had impaired cancer-specific survival compared with patients with only minor interruption (<7 d) (P = 0.06). Bowel toxicity was associated with prolonged RT (P = 0.03) duration as well as increased relapse probability (P = 0.05). Skin toxicity correlated with institution and was found in 79% (Montreal) and 28% (Zurich) (P < 0.0001).ConclusionsThe study design did not allow demonstrating a clear difference in efficacy between the treatment regimens with or without short mandatory split. Cause-specific outcome appears to be impaired by unplanned prolonged interruption.

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“…All eventually had a complete clinical response and currently have no evidence of disease. Some studies have not shown an association between treatment breaks with worse clinical outcomes, including a pooled data analysis of RTOG 87-04 and 98-11 [30,31]. Although the effect of a treatment break is unclear, an uninterrupted treatment course should be delivered if possible.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of anal cancer treated with definitive IMRT-based chemoradiation

et al. 2012

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Objective Despite excellent long-term outcomes, definitive chemoradiation (CRT) for squamous cell carcinoma (SqCC) of the anal canal with traditional radiotherapy techniques results in significant morbidity. Accruing data supports intensity-modulated radiotherapy (IMRT)-based treatment, and we report our institutional experience using this approach. Methods We reviewed patients with nonmetastatic anal canal SqCC treated with definitive IMRT-CRT. Clinically node-negative patients initially received 36 Gy to the elective pelvic and inguinal lymph nodes and 40 Gy to gross tumor volume (GTV) while node-positive patients received 45 and 50 Gy, respectively. All patients were considered for a GTV boost depending on the degree of clinical response and acute treatment-related toxicity.Results We identified 52 patients with T1-4N0-3M0 SqCC of the anal canal. Median follow-up was 21 months (range, 7.7-68.1 months). Two-year locoregional control, overall survival, disease-free survival, distant metastasis-free survival, and colostomy-free survival were 94.6, 100, 82.6, 90, and 94.7 %, respectively. Acute grade 3+ nonhematologic and hematologic toxicities were observed in 21.1 and 63.5 %, respectively. No acute grade 4 nonhematologic toxicity was observed. Conclusion Our series demonstrates that definitive IMRTbased chemoradiation with standard fractionation for anal SqCC results in excellent outcomes with minimal toxicity.

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Chemoradiotherapy in patients with anal cancer: Impact of length of unplanned treatment interruption on outcome

Cited by 26 publications

References 23 publications

Sphincter preservation in anal cancer: A brief review

Sphincter preservation in anal cancer: A brief review

Chemo-radiation with or without mandatory split in anal carcinoma: experiences of two institutions and review of the literature

Outcomes of anal cancer treated with definitive IMRT-based chemoradiation

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