Intensity-Modulated Radiotherapy Associated With Improved Survival Outcome in Anal Cancer

Abstract

PurposeTo describe the survival and toxicity outcome from a single-centre experience in patients with squamous cell cancer of the anal canal (SCC-AC), related to the impact of technological advances in diagnostics and radiation techniques.Material and MethodsA retrospective cohort study was performed after the approval of the institutional ethical committee (EK 478-21). We identified 142 patients in our registry, who received radical treatment for SCC-AC between 2000 and 2020. Fifty-five patients had FDG PET/CT for initial staging and target volume delineation, 87.33% received concomitant chemoradiotherapy (CRT), 64 patients were treated with 3-dimensional conformal radiotherapy (3DRT) between 2000-2009, and 78 patients with intensity-modulated radiotherapy (IMRT) between 2009-2020. Endpoints for the analysis included locoregional relapse-free survival (LRFS), disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS). Acute and late toxicities were also reported.ResultsAt a median follow-up of 31.2 months, the median overall survival was 135 months, 5-year LRFS was 73.1%, 5-year DFS was 65.3%, and 5-year CSS was 75.3%. The use of IMRT was associated with shorter treatment duration. In the univariate analysis, IMRT was associated with significantly improved DFS and CSS for the whole cohort and significantly improved DFS, OS, and CSS for patients who received CRT. In the multivariate analysis, IMRT was associated with the improvement of all survival paraments. The use of FDG PET/CT did not translate into an improvement in the survival outcomes in both univariate and multivariate analyses. Grade-3 and more dermatological toxicities occurred less frequently, but hematological toxicities were more frequent in the IMRT-group. Late side effects and colostomies were less frequently reported in the IMRT group.ConclusionThe use of IMRT in the management of SCC-AC was associated with improvement of the oncological outcomes with improved toxicity profiles in this long-term single-centre experience.

Body Composition as a Predictor of the Survival in Anal Cancer

“…Interestingly, the median of VSR in males was significantly higher than in females; however, this was different in the case of BMI, where there were no gender-related differences. This phenomenon may help explain the difference in OS and CSS between males and females in anal cancer that was reported in the survival analysis in this study and a previous analysis from our group with a larger collective of patients [ 30 ].…”

“…In the current study, we included patients from our register who were only treated with IMRT due to the possible influence of the treating modality on survival and the availability of imaging data [ 30 ]. Our results show a correlation between BMI with both visceral and subcutaneous adipose tissue but did not show any correlation between BMI and VSR; this may indicate that VSR could provide a different prognostic value than BMI.…”