Efficacy and safety of helical tomotherapy with daily image guidance in anal canal cancer patients

Abstract

2002), and 33 presented a N1-3 disease. Radiotherapy consisted of 36 Gy (1.8 Gy/fraction) delivered on the pelvis and on the anal canal, with a sequential boost up to 59.4 Gy (1.8 Gy/fraction) delivered to the anal and to nodal gross tumor volumes. Concomitant chemotherapy was delivered in 73 patients, mainly using mitomycin C and 5-fluorouracil (n ¼ 30) or mitomycin C and capecitabine combination (n ¼ 37). After a median follow-up period of 47 months (range 3-75), the five-year LC rate was 83.8% (95% CI 76.2-91.4%). Seven patients underwent a colostomy because of local recurrence (n ¼ 5) or pretreatment dysfunction (n ¼ 2). Overall incidence of grade 3 acute toxicity was 24%, mainly as erythema (n ¼ 15/19) or diarrhea (n ¼ 7/19). Two patients presented a late grade 3 gastrointestinal toxicity (anal incontinence). No grade 4 acute or late toxicity was recorded.Conclusions HT with daily IGRT is efficacious and safe in the treatment of anal canal cancer patients, and is considered in our department standard of care in this clinical setting.

Modern intensity-modulated radiotherapy with image guidance allows low toxicity rates and good local control in chemoradiotherapy for anal cancer patients

“…Similar data are reported in a multi-institutional retrospective study published by Salama et al, showing a rate of 15.1% of grade 3 acute GI toxicity (Salama et al 2007), lower than the rate reported in the RTOG 98-11 trial (Gunderson et al 2012). De Bari et al showed an overall rate of 22% of acute toxicity (mainly cutaneous), in a large monocentric series of patients treated with tomotherapy (De Bari et al 2016). Franco et al (2016) showed comparable rates of acute toxicity in a retrospective analysis of 39 patients treated with VMAT and simultaneous integrated boost (SIB).…”

“…Median overall treatment time for EBRT with or without CT was 57 days (interquartile range 52-59). The dosimetric constraints were similar in the three centers and have been previously described (De Bari et al 2016). In two out the three participating Centers (CHUV and CL), the IGRT was performed with daily MV-CBCT performed with HT.…”

“…Both these patients have been treated with a curative goal and were alive and disease-free the moment of this analysis, 43 and 66 months after the end of the treatment. Details about these patients have been previously reported (De Bari et al 2016).…”

“…Moreover, imageguided radiation therapy (IGRT) is being largely adopted in the daily clinical practice, as it allows the online and offline daily verification and correction of the setup of the patients and a reduction of treatment volumes, with a consequent reduction of toxicity rates (Conde-Moreno et al 2012;Hajj and Goodman 2015). IMRT and IGRT have been recently adopted also in the treatment of anal canal cancer patients, and results are promising in terms of local control and toxicity (De Bari et al 2016;Han et al 2014;Lestrade et al 2017;Kachnic et al 2013;Vieillot et al 2012;Call et al 2016), with a particular interest in some particular classes of patients, presenting an intrinsic increased risk of higher toxicity (Lestrade et al 2013;Hauerstock et al 2010;White et al 2017). Unfortunately, the sample size of studies reporting the results of IMRT in anal cancer treatment was often limited, with also short follow-up time (often < 24 months).…”

Management of locally advanced anal canal carcinoma with intensity-modulated radiotherapy and concurrent chemotherapy

“…Compared to 3D-CRT, arc therapy and helical tomotherapy present the following advantages: lower doses to the organs at risk with lesser risk for acute and late toxicity events; possibility of skipping the irradiation-free gap; and reduce intermediate and high doses to normal tissues [72,73]. Joseph et al reported on quality of life in a prospective study with patients treated with helical tomotherapy and concurrent chemotherapy.…”