Multi-institutional Comparison of Intensity Modulated Photon Versus Proton Radiation Therapy in the Management of Squamous Cell Carcinoma of the Anus

Mohiuddin, Jahan J.; Jethwa, Krishan R.; Grandhi, Nikhil; Breen, William; Wang, Xingmei; Anvari, Akbar; Lin, Hui-Ling; Sandhyavenu, Harigopal; Doucette, Abigail; Plastaras, John P.; Rule, William G.; Metz, James M.; Merrell, Kenneth W.; Sio, Terence T.; Ashman, Jonathan B.; Haddock, Michael G.; Ben‐Josef, Edgar; Hallemeier, Christopher L.; Wojcieszynski, Andrzej P.

doi:10.1016/j.adro.2021.100744

Cited by 9 publications

(8 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13 The authors suggest that there may be more intestinal wall damage at the distal end of the proton beam because of higher linear energy transfer, which could be allowing gut translocation of bacteria that eventually causes febrile neutropenia. 13 An ongoing randomized trial is comparing IMRT and IMPT in anal cancer patients (NCT04462042) with grade 2+ hematologic toxicity as the primary endpoint. Given that our study shows no significant decrease in hematologic toxicity in patients treated with IMPT versus those treated with IMRT, the ongoing trial may be negative because of selection of hematotoxicity as the primary endpoint.…”

Section: Discussionmentioning

confidence: 99%

“…However, 28% of patients treated with IMPT developed neutropenia compared with 15% of patients treated with IMRT 13. The authors suggest that there may be more intestinal wall damage at the distal end of the proton beam because of higher linear energy transfer, which could be allowing gut translocation of bacteria that eventually causes febrile neutropenia 13. An ongoing randomized trial is comparing IMRT and IMPT in anal cancer patients (NCT04462042) with grade 2+ hematologic toxicity as the primary endpoint.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hematologic Toxicity Comparison of Intensity Modulated Proton Therapy and Intensity Modulated Radiation Therapy in Anal Cancer Patients

Nelson

Tadesse

Sudhoff

et al. 2022

American Journal of Clinical Oncology

View full text Add to dashboard Cite

Purpose: We hypothesize that hematologic toxicity will be lower in anal cancer patients treated definitively with intensity modulated proton therapy (IMPT) compared with patients treated with intensity modulated radiation therapy (IMRT). Methods: Patients enrolled on a prospective feasibility trial assessing the use of IMPT for anal cancer were compared with contemporaneous patients treated with IMRT. Blood counts were collected during chemoradiation. Hematologic events were graded according to CTCAE version 5.0. Pelvic bone marrow (PBM) and positron emission tomography-defined active bone marrow (ABM) were defined and contoured for each patient. Toxicity rates, PBM and ABM dose metrics were compared between groups. Results: Forty-one patients treated with definitive chemoradiation for anal cancer between 2015 and 2021 were included in this analysis. Of the evaluable patients, 14 patients were treated with IMPT and 27 were treated with IMRT. All PBM dose metrics were lower in patients receiving IMPT. Patients treated with IMPT versus IMRT also had a significantly lower ABM mean dose (1996 vs. 3073 Gy, P<0.01). However, there was no statistically significant difference in hematologic toxicity between the groups. Seventy percent of patients treated with IMRT had at least 1 grade ≥3 hematologic event compared with 86% in the IMPT group (P=0.48). Conclusion: Proton treatment reduced bone marrow doses but was not associated with lower hematologic toxicity when compared with IMRT.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hematologic Toxicity Comparison of Intensity Modulated Proton Therapy and Intensity Modulated Radiation Therapy in Anal Cancer Patients

Nelson

Tadesse

Sudhoff

et al. 2022

American Journal of Clinical Oncology

View full text Add to dashboard Cite

show abstract

“…The only comparative study so far is one by Mohiuddin and colleagues [ 96 ]. In this retrospective, multi-institutional comparison, 208 patients with anal SCC either received IMPT ( n = 58) or IMRT ( n = 150).…”

Section: Anorectal Cancermentioning

confidence: 99%

Proton Therapy in the Management of Luminal Gastrointestinal Cancers: Esophagus, Stomach, and Anorectum

Kobeissi

Simone

Hilal

et al. 2022

Cancers

View full text Add to dashboard Cite

While the role of proton therapy in gastric cancer is marginal, its role in esophageal and anorectal cancers is expanding. In esophageal cancer, protons are superior in sparing the organs at risk, as shown by multiple dosimetric studies. Literature is conflicting regarding clinical significance, but the preponderance of evidence suggests that protons yield similar or improved oncologic outcomes to photons at a decreased toxicity cost. Similarly, protons have improved sparing of the organs at risk in anorectal cancers, but clinical data is much more limited to date, and toxicity benefits have not yet been shown clinically. Large, randomized trials are currently underway for both disease sites.

show abstract

“…5,7 Intensity-modulated proton therapy (IMPT) has been shown to significantly decrease the dose to pelvic organs at risk compared with IMRT providing the rationale for potential toxicity reduction. [8][9][10][11] However, it is unknown whether IMPT leads to a clinically significant decrease in acute toxicities. The primary aims of the trial were to evaluate the feasibility of IMPT use in the anal cancer population and to obtain point estimates for common terminology criteria for adverse events (CTCAE)-reported ≥ grade 2 and ≥ grade 3 toxicities with 95% CIs to determine whether IMPT warrants additional study in this population.…”

mentioning

confidence: 99%

“…However, patients treated with IMRT continue to suffer from high rates of toxicity with 83% of patients having ≥ grade 3 acute toxicity and 20% of patients having ≥ grade 3 late toxicity 5,7 . Intensity-modulated proton therapy (IMPT) has been shown to significantly decrease the dose to pelvic organs at risk compared with IMRT providing the rationale for potential toxicity reduction 8–11 . However, it is unknown whether IMPT leads to a clinically significant decrease in acute toxicities.…”

mentioning

confidence: 99%

Feasibility Trial of Intensity Modulated Proton Therapy to Reduce Toxicity in Anal Cancer Patients

Nelson¹,

Meier²,

Zhang

et al. 2023

American Journal of Clinical Oncology

View full text Add to dashboard Cite

Purpose: The purpose of this trial was to assess the patient and physician-reported toxicity in anal cancer patients undergoing definitive chemoradiation with intensity-modulated proton therapy (IMPT). Methods: Patients with stage II and III anal cancer were treated with IMPT. All patients received 2 cycles of 5-fluorouracil and mitomycin concurrently with radiation. Toxicity was assessed at baseline, weekly during chemoradiation, and in follow-up using physician-graded common terminology criteria for adverse events (CTCAE) v 4.0 and PRO-CTCAE. The primary endpoint was to define point estimates and 95% CI for acute ≥ grade 2/3 gastrointestinal (GI), genitourinary (GU), dermatologic, and hematologic toxicity. The proportion of PRO-CTCAE questions scored ≥3 for each domain was compared with the baselinse. The proportion of ≥ grade 2 and ≥ grade 3 toxicities were compared with historic intensity-modulated radiotherapy patients treated on RTOG 0529. Results: Fourteen patients were enrolled from 2017 to 2020. Rates of physician-reported GI, GU, dermatologic, and hematologic toxicity were not significantly different between patients treated with IMPT compared with patients treated with intensity-modulated radiotherapy. Rates of patient-reported dermatologic and GU toxicity were low at baseline with a peak at week 6 (91% and 58% PRO-CTCAE items ≥ grade 3, respectively) and normalization to baseline 3 months after IMPT. In contrast, the proportion of high-grade PRO-CTCAE GI scores was 40% at baseline, which persisted through 1-year posttreatment. Conclusions: Clinician-reported toxicity was not improved with IMPT in the context of this underpowered trial. High-grade GI symptoms persisted for 12 months and were similar to baseline. Additional measures are needed to minimize acute and chronic toxicity related to chemoradiation.

show abstract

Multi-institutional Comparison of Intensity Modulated Photon Versus Proton Radiation Therapy in the Management of Squamous Cell Carcinoma of the Anus

Cited by 9 publications

References 31 publications

Hematologic Toxicity Comparison of Intensity Modulated Proton Therapy and Intensity Modulated Radiation Therapy in Anal Cancer Patients

Hematologic Toxicity Comparison of Intensity Modulated Proton Therapy and Intensity Modulated Radiation Therapy in Anal Cancer Patients

Proton Therapy in the Management of Luminal Gastrointestinal Cancers: Esophagus, Stomach, and Anorectum

Feasibility Trial of Intensity Modulated Proton Therapy to Reduce Toxicity in Anal Cancer Patients

Contact Info

Product

Resources

About