Efficacy and toxicity of chemoradiation in patients with anal cancer - a retrospective analysis

Abstract

BackgroundConcurrent chemotherapy and radiation therapy is the preferred standard of care for patients with anal cancer. Several studies have suggested a benefit of intensity-modulated radiation therapy (IMRT) compared with 3D-conformal radiation (3D-CRT) regarding acute toxicity. This study evaluates outcome and toxicity of patients undergoing IMRT/Tomotherapy or 3D-CRT at our institution.MethodsA cohort of 105 anal cancer patients was treated with chemoradiation or radiation alone (16.2%) between January 2000 and December 2011. 37 patients received 3D-CRT while 68 patients were treated with IMRT. Follow-up exams were performed every 3 to 6 months for a minimum of 3 years and then annually.ResultsMedian follow-up was 41.4 months (2.8 – 158.4). Overall survival (OS), Progression-free survival (PFS) and local control (LC) at 3 years was 70.3%, 66.5%, 78.3% in the 3D-CRT group and 82.9%, 66.5%, 75.3% in the IMRT group without statistically significant difference. 3-year Colostomy-free survival (CFS) was 85.7% in the IMRT/Tomotherapy group and 91.8% in the 3D-CRT group (p = 0.48). No grade 4 toxicity was found in both groups. Severe (G2/3) acute skin toxicity (94.6% vs. 63.2%; p < 0.001) and acute gastrointestinal toxicity rate (67.6% vs. 47.1%; p = 0.03) was significantly higher with 3D-CRT compared to IMRT/Tomotherapy.ConclusionThe use of IMRT can reduce acute severe side effects of the skin and gastrointestinal tract but did not demonstrate improved results regarding OS, PFS, LC and CFS.

An Innovative Complex of Benzene-Poly-Carboxylic Acid and Molybdenum, for Prevention and Treatment of Radiation Dermatitis

“…The study demonstrated that IMRT could reduce severe acute skin toxicity significantly (p<0.001) compared to 3D-CRT. No toxicity grade 4 was observed and G2/3 toxicity was reduced from 94.6% to 63.2%) [25]. No effect on overall survival, progression-free survival or on local control was observed.…”

A tumor control probability model for anal squamous cell carcinoma

“…Thirteen publications incorporating 645 patients were identified, details of individual series are presented in Table 1 [27][28][29][30][31][32][33][34][35][36][37][38].…”

Systematic review of outcome measures following chemoradiotherapy for the treatment of anal cancer (CORMAC)

“…Definitions used incorporated criteria for grading the level of response; modality of assessment; and timing of assessment and there was heterogeneity in all of these aspects (Table S4). Twenty-two different definitions were used in the 23 studies; the most commonly used criteria for assessing the level of response was the Response Evaluation Criteria In Solid Tumours (RECIST), used in six studies [8,[21][22][23][24][25]. However only two of the studies using RECIST assessed response at the same time points [26,27].…”