Prospective phase II study of tomotherapy based chemoradiation treatment for locally advanced anal cancer

Joseph, Kurian; Nijjar, Yugmel; Warkentin, Heather; Schiller, Dan; Tankel, Keith; Usmani, Nawaid; Severin, Diane; Ghosh, Sunita; Syme, Alasdair; Nijjar, Tirath; Mulder, Karen; Doll, Corinne; Wong, Clarence; Field, Colin

doi:10.1016/j.radonc.2015.08.008

Cited by 17 publications

(14 citation statements)

References 28 publications

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“…This is because ASCC is rare in Asia [ 14 , 15 ]. To the best of our knowledge, all available information on IMRT for ASCC has been collected in the West [ 5 , 16 - 22 ]. Such data may apply to Asians; however, Westerners have larger pelvic cavities and more abdominal fat than Asians.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric advantages and clinical outcomes of simultaneous integrated boost intensity-modulated radiotherapy for anal squamous cell carcinoma

et al. 2017

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PurposeThe purpose of this study was to explore the dosimetric difference between simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) and three-dimensional conformal radiotherapy (3DCRT), and the clinical outcomes of anal squamous cell carcinoma (ASCC) chemoradiotherapy featuring SIB-IMRT. Materials and MethodsThis study included ten patients with ASCC who underwent chemoradiotherapy using SIB-IMRT with 5-fluorouracil and mitomycin C. SIB-IMRT delivered 54 Gy to each primary tumor plus metastatic lymph nodes and 45 Gy to regional lymph nodes, in 30 fractions. Four patients received additional boosts to the primary tumors and metastatic lymph nodes; the median total dose was 54 Gy (range, 54 to 60 Gy). We additionally created 3DCRT plans following the Radiation Therapy Oncology Group 9811 protocol to allow dosimetric comparisons with SIB-IMRT. Locoregional control, overall survival, and toxicity were calculated for the clinical outcome evaluation. ResultsCompared to 3DCRT, SIB-IMRT significantly reduced doses to the external genitalia, bladder, and intestine, delivering the doses to target and elective nodal region. At a median follow-up time of 46 months, 3-year locoregional control and overall survival rates were 88.9% and 100%, respectively. Acute toxicities were treated conservatively. All patients completed radiotherapy with brief interruptions (range, 0 to 2 days). No patient experienced ≥grade 3 late toxicity during the follow-up period. ConclusionThe dosimetric advantages of SIB-IMRT appeared to reduce the toxicity of chemoradiotherapy for ASCC achieving high locoregional control in the extended period.

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Section: Discussionmentioning

confidence: 99%

Dosimetric advantages and clinical outcomes of simultaneous integrated boost intensity-modulated radiotherapy for anal squamous cell carcinoma

et al. 2017

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“…also reported that skin bolus was not necessary when dose‐painted IMRT technique is used. Phase II study by Joseph et al . using Tomotherapy with concurrent chemotherapy for the treatment of anal cancer has reported a higher incidence of ≥ grade 3 skin toxicity when skin bolus was used.…”

Section: Discussionmentioning

confidence: 99%

“…Kachnic et al 4 also reported that skin bolus was not necessary when dose-painted IMRT technique is used. Phase II study by Joseph et al 7 using Tomotherapy with concurrent chemotherapy for the treatment of anal cancer has reported a higher incidence of ≥ grade 3 skin toxicity when skin bolus was used. Reduction of treatmentrelated toxicity remains a priority upon introducing modern radiation techniques like VMAT, IMRT or Tomotherapy for the treatment of anal cancer without compromising dose profiles to PTV.…”

Section: Discussionmentioning

confidence: 99%

Peri‐anal surface dose in anal canal VMAT radiotherapy

Joseph

Rose²,

Warkentin

et al. 2018

J Med Imag Rad Onc

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“…The numerous series published used a wide range of CTV to PTV margins ranging from 5 mm to 15 mm [31], [32], [33], [34] but none of the published literature suggests individualised margins for different targets. This widespread variation suggests there remains uncertainty regarding the correct margin and the need for studies similar to our own.…”

Section: Discussionmentioning

confidence: 99%

Quantifying target-specific motion in anal cancer patients treated with intensity modulated radiotherapy (IMRT)

Durrant

Robinson

Hawkins

et al. 2016

Radiotherapy and Oncology

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Background and purposeIntensity modulated radiotherapy requires all target areas to be treated by a single radiotherapy plan. In anal cancer, the pelvic nodes, inguinal nodes and primary tumour represent three different targets. We aim to calculate target-specific motion in anal cancer radiotherapy, when delivered using a single pelvic online auto-match.Materials and methodsTwenty consecutive patients treated using IMRT at a single institution were studied. CBCTs were retrospectively re-matched around the inguinal nodes and primary tumour. Match values were recorded relative to origin, defined as pelvic CBCT auto-match. Systematic and random errors were quantified to determine target-specific motion and suggested margins calculated using van Herk formulae.ResultsThe suggested margins to cover the independent motion of the inguinal and anal targets for LR, CC and AP set up around the inguinal nodes were 1.5 mm, 2.7 mm and 2.8 mm; and the primary tumour were, 4.6 mm, 8.9 mm and 5.2 mm respectively.ConclusionsTarget-specific set up will likely result in reduced treatment volumes and as such reduced toxicity. This is the first time a relationship has been described between pelvic bones, inguinal nodes and primary tumour. The PLATO study will prospectively assess the toxicity and outcomes of this target-specific margins strategy.

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Prospective phase II study of tomotherapy based chemoradiation treatment for locally advanced anal cancer

Cited by 17 publications

References 28 publications

Dosimetric advantages and clinical outcomes of simultaneous integrated boost intensity-modulated radiotherapy for anal squamous cell carcinoma

Dosimetric advantages and clinical outcomes of simultaneous integrated boost intensity-modulated radiotherapy for anal squamous cell carcinoma

Peri‐anal surface dose in anal canal VMAT radiotherapy

Quantifying target-specific motion in anal cancer patients treated with intensity modulated radiotherapy (IMRT)

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