Intensity-modulated Radiotherapy for Anal Cancer: Dose–Volume Relationship of Acute Gastrointestinal Toxicity and Disease Outcomes

Ng, Michael; Ho, Huong; Skelton, Jane; Guerrieri, Mario; Guiney, Michael; Chao, Michael; Blakey, David C.; MacLeod, Campbell; Amor, H; Subramanian, Brindha; Melven, L.

doi:10.1016/j.clon.2018.07.020

Cited by 11 publications

(7 citation statements)

References 21 publications

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“…Although outcomes are good with a 5-year disease-free survival of 58-78%, there remains a poor prognostic group with a local relapse rate of over 50% [6,7]. It is suggested that dose escalation to the primary tumour may result in improved local control [8], however due to complications including faecal incontinence, mucus discharge, vaginal stricturing and rectal bleeding, dose escalation to all patients may result in increased late side effects to patients unnecessarily [8][9][10][11][12][13][14]. Better and early identification of the group of patients in need of radiotherapy treatment intensification would allow clinicians to tailor radiotherapy dose to prevent relapse while mitigating these late side effects.…”

Section: Introductionmentioning

confidence: 99%

Oxygen-enhanced MRI MOLLI T1 mapping during chemoradiotherapy in anal squamous cell carcinoma

Bluemke

Bulte

Bertrand

et al. 2020

Clinical and Translational Radiation Oncology

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a b s t r a c tBackground and purpose: Oxygen-enhanced magnetic resonance imaging (MRI) and T1-mapping was used to explore its effectiveness as a prognostic imaging biomarker for chemoradiotherapy outcome in anal squamous cell carcinoma. Materials and methods: T2-weighted, T1 mapping, and oxygen-enhanced T1 maps were acquired before and after 8-10 fractions of chemoradiotherapy and examined whether the oxygen-enhanced MRI response relates to clinical outcome. Patient response to treatment was assessed 3 months following completion of chemoradiotherapy. A mean T1 was extracted from manually segmented tumour regions of interest and a paired two-tailed t-test was used to compare changes across the patient population. Regions of subcutaneous fat and muscle tissue were examined as control ROIs. Results: There was a significant increase in T1 of the tumour ROIs across patients following the 8-10 fractions of chemoradiotherapy (paired t-test, p < 0.001, n = 7). At baseline, prior to receiving chemoradiotherapy, there were no significant changes in T1 across patients from breathing oxygen (n = 9). In the post-chemoRT scans (8-10 fractions), there was a significant decrease in T1 of the tumour ROIs across patients when breathing 100% oxygen (paired t-test, p < 0.001, n = 8). Out of the 12 patients from which we successfully acquired a visit 1 T1-map, only 1 patient did not respond to treatment, therefore, we cannot correlate these results with clinical outcome. Conclusions: These clinical data demonstrate feasibility and potential for T1-mapping and oxygen enhanced T1-mapping to indicate perfusion or treatment response in tumours of this nature. These data show promise for future work with a larger cohort containing more non-responders, which would allow us to relate these measurements to clinical outcome.

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Section: Introductionmentioning

confidence: 99%

Oxygen-enhanced MRI MOLLI T1 mapping during chemoradiotherapy in anal squamous cell carcinoma

Bluemke

Bulte

Bertrand

et al. 2020

Clinical and Translational Radiation Oncology

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“…However, approximately 50% of patients will be cured by standard radiotherapy doses. In these patients, unnecessary radiotherapy dose escalation will only serve to increase late toxicities (6)(7)(8)(9) which can be lifelong and significantly affect quality of life. These include diarrhoea, faecal incontinence, dyspareunia, and erectile dysfunction (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study of Diffusion-weighted Magnetic Resonance Imaging as an Early Prognostic Biomarker in Chemoradiotherapy in Squamous Cell Carcinomas of the Anus

et al. 2020

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The use of diffusion-weighted magnetic resonance imaging as a prognostic marker of treatment response would enable early individualisation of treatment. We aimed to quantify the changes in mean apparent-diffusion-coefficient (∆ADC Mean ) between a DW-MRI at diagnosis and on fraction 8-10 of chemoradiotherapy (CRT) as a biomarker for cellularity, and correlate these with ASCC recurrence. Methods and materialsThis prospective study recruited patients with localised anal cancer between October 2014 and November 2017. DW-MRI was performed at diagnosis and after fraction 8-10 of radical CRT. A region of interest (ROI) was delineated for all primary tumours and any lymph nodes >2 cm on highresolution T 2 -weighted images and propagated to the ADC map. Routine clinical follow up was collected from NHS electronic systems. ResultsTwenty-three of 29 recruited patients underwent paired DW-MRI scans. 26 ROIs were delineated among the 23 evaluable patients. The median (range) tumour volume was 13.6 cm 3 (2.8 cm 3 to 84.9 cm 3 ). Ten of 23 patients had lesions with ∆ADC Mean ≤20%. With a median follow-up of 41.2 months, 4 patients either failed to have a complete response to CRT, or subsequently relapsed. Three of 4 patients with disease relapse had lesions demonstrating ∆ADC Mean ≤20%, the other patient with persistent disease had ∆ADC Mean of 20.3%. ConclusionsWe demonstrated a potential correlation between patients with ∆ADC Mean ≤20% and disease relapse.Further investigation of the prognostic merit of DW-MRI change is needed in larger, prospective cohorts.

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“…Currently intensity-modulated radiation therapy (IMRT) represents the standard of care in the United States (US), even if it is not adopted worldwide for ASCC; its better management in terms of efficacy and toxicity could allow the concomitant role of CDDP to be reassessed. 11 Since 2010, IMRT has been proposed in our institute, concomitantly with CDDP plus oral fluoropyrimidine capecitabine (C) as a possible alternative to the MMC-5FU regimen in patients who preferred to avoid central vein catheter and/ or when an increased hematological toxicity related to clinical history was expected.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cisplatin plus capecitabine concomitant with intensity-modulated radiation therapy in non-metastatic anal squamous cell carcinoma: the experience of a single research cancer center

et al. 2020

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Background and Aims: The standard treatment of non-metastatic anal squamous cell carcinoma (ASCC) consists of chemotherapy with mitomycin (MMC) plus 5-fluorouracil (5FU) for 1–2 cycles concomitant with pelvic radiotherapy. Subsequent studies introduced cisplatin (CDDP) combined with 5FU, with unclear results. We evaluated the doublet capecitabine (C) and CDDP as a possible alternative to MMC-5FU regimen concomitant with intensity-modulated radiation therapy (IMRT). Patients and Methods: We carried out a retrospective study on 67 patients affected by stage I–III ASCC, treated with CDDP (60–70 mg/m2 every 21 days for two courses) plus C (825 mg/m2 twice daily for 5 days/week) chemotherapy concomitant with IMRT for curative intent. Results: At a median follow up of 41 months, the clinical complete response calculated at the 6-month time-point (6-moCR), the 6-month objective response rate and the 6-month disease control rate were 93%, 94%, and 99%, respectively. Disease-free survival rates at 1, 2, and 3 years were 89%, 87%, and 85%, while the overall survival rates at 1 and 2 years were 100% and 95%. The colostomy-free survival rates were 90% at 1 year and 88% at 2 years. Grade 3–4 acute adverse events were reported in 61% of patients; predominantly skin toxicity (46%) and limited hematological toxicity (12%). Conclusion: In this retrospective study, chemotherapy with C plus CDDP concomitant with IMRT proved safe and effective, and may represent a possible alternative option to standard MMC-containing regimen for curative intent.

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Intensity-modulated Radiotherapy for Anal Cancer: Dose–Volume Relationship of Acute Gastrointestinal Toxicity and Disease Outcomes

Cited by 11 publications

References 21 publications

Oxygen-enhanced MRI MOLLI T1 mapping during chemoradiotherapy in anal squamous cell carcinoma

Oxygen-enhanced MRI MOLLI T1 mapping during chemoradiotherapy in anal squamous cell carcinoma

A Prospective Study of Diffusion-weighted Magnetic Resonance Imaging as an Early Prognostic Biomarker in Chemoradiotherapy in Squamous Cell Carcinomas of the Anus

Cisplatin plus capecitabine concomitant with intensity-modulated radiation therapy in non-metastatic anal squamous cell carcinoma: the experience of a single research cancer center

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