Reduced radiation dose for elective nodal irradiation in node-negative anal cancer: back to the roots?

Henkenberens, Christoph; Meinecke, Daniela; Stoll, M.; Bremer, Michael; Christiansen, Hans

doi:10.1007/s00066-015-0885-4

Cited by 8 publications

(5 citation statements)

References 33 publications

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“…Further, the inguinal lymph node control rate was 96% and can be accomplished with minimal acute or long-term complications 23. Two recent studies have shown that with radiation to elective node irradiation, excellent nodal control was achieved in the inguinal region, with control rates as high as 98.5% and 100.0% 29, 30. A French study showed that the 5-year cumulative rate of inguinal recurrence was 2% and 16% in prophylactic inguinal irradiation (PII) and no PII groups, respectively ( p =0.006).…”

Section: Discussionmentioning

confidence: 99%

Anal adenocarcinoma requires prophylactic inguinal nodal treatment: Results from a single Chinese institution

Guo

Mao

et al. 2017

J. Cancer

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Background: Literature pertaining to prophylactic inguinal nodal treatment for anal adenocarcinoma in China is scarce.Methods: In this retrospective study, we analyzed 126 patients from 1965 to 2015. Among these, 67 patients received surgery only, 18 patients received chemoradiotherapy only, 27 patients received a combination of both, and the remaining 14 patients received palliative treatment.Results: The median follow up period was 30 months. The 1-year, 3-year, and 5-year overall survival rates were 85.8%, 62.5%, and 43.4%, respectively. The 5-year overall survival was 46.9% for patients with negative inguinal lymph nodes and 19.1% for patients with positive inguinal lymph nodes (p=0.007). The overall 5-year inguinal node relapse-free survival was 83.0%. The 5-year inguinal node relapse-free survival was 87.5% for stage I, 86.9% for stage II, and 76.5% for stage III cancers. Among those with negative inguinal nodes, the 5-year inguinal node relapse-free survival was 85.7% for negative regional lymph nodes and 75.4% for positive regional lymph nodes (p=0.089).Conclusion: Inguinal lymph node is a high-risk subclinical area. Prophylactic inguinal nodal treatment is necessary for patients with anal adenocarcinoma irrespective of positive or negative inguinal lymph nodes.

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Section: Discussionmentioning

confidence: 99%

Anal adenocarcinoma requires prophylactic inguinal nodal treatment: Results from a single Chinese institution

Guo

Mao

et al. 2017

J. Cancer

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“…The Accord 03 study demonstrated that intensifying treatment with either induction chemotherapy or a higher radiotherapy dose did not further improve outcomes (18) whereas the Mitra et al study reported outcomes comparable, if not marginally better, than our ndings but did so with a lower radiotherapy dose (6). Further studies to address nd the optimum dose of radiotherapy to balance disease outcome with toxicity are warranted (10,22). Results from the ongoing PersonaLising Anal cancer radioTherapy dOse trial (PLATO), incorporating the ACT3, ACT4 and ACT5 trials are eagerly awaited.…”

Section: Discussionmentioning

confidence: 99%

Treatment results for patients with squamous-cell carcinoma of the anus, a single institution retrospective analysis

Neelis

Kip

Speetjens

et al. 2022

Preprint

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Background and purpose To gain insight into the treatment outcomes for anal cancer at a retrospective analysis was performed with a special emphasis on trends in outcome and toxicities over time and on treatment of elderly patients. Materials and methods Medical records of 98 consecutive patients with squamous cell carcinoma of the anus of all stages treated with curative intent between 01-01-2009 and 31-12-2018 were analyzed with follow up until 31-12-2020. Standard tumor and pathological lymph node dose were 59.4Gy or 60Gy, elective nodal regions were treated with 45Gy. Radiotherapy techniques in this period evolved from 3D conformal to IMRT and VMAT. In 23 patients electron beams were used. Results Median age was 63 years (range 41 – 88), majority female patients (60%). Twenty three patients were > 75 years old. The TNM stages were I, II, IIIA, and IIIB in 18%, 40%, 15% and 27%, fifty-eight % of patients had N0 status. Concurrent mitomycin C and 5-fluoruracil-based chemotherapy was given in 63 patients (64%). Five-year overall survival (OS), disease free survival (DFS), locoregional control (LRC) and colostomy free survival (CFS) were 71%, 80%, 82%, and 82% for the whole group. Results in patients > 75 years of age were not statistically different from those in younger patients. With the introduction of more conformal techniques DFS did not change and toxicities decreased. Conclusion Real word treatment outcomes per disease stage were in line with what is reported in literature. Older patients should also be offered treatment with curative intent.

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“…The Accord 03 study demonstrated that intensifying treatment with either induction chemotherapy or a higher radiotherapy dose did not further improve outcomes [ 19 ] whereas the Mitra et al study reported outcomes comparable, if not marginally better, than our findings but did so with a lower radiotherapy dose [ 7 ]. Further studies to find the optimum dose of radiotherapy to balance disease outcome with toxicity are warranted [ 11 , 23 ]. Results from the ongoing PersonaLising Anal cancer radioTherapy dOse trial (PLATO), incorporating the ACT3, ACT4 and ACT5 trials are eagerly awaited.…”

Section: Discussionmentioning

confidence: 99%

Treatment results for patients with squamous-cell carcinoma of the anus, a single institution retrospective analysis

et al. 2022

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Background and purpose To gain insight into the treatment outcomes for anal cancer a retrospective analysis was performed with a special emphasis on trends in outcome and toxicities over time and on treatment of elderly patients. Materials and methods Medical records of 98 consecutive patients with squamous cell carcinoma of the anus of all stages treated with curative intent between 01-01-2009 and 31-12-2018 were analyzed with follow up until 31-12-2020. Standard tumor and pathological lymph node dose were 59.4 Gy (median 59.4 Gy, range 59.4–70 Gy) or 60 Gy (no deviation from intended dose), elective nodal regions were treated with 45 Gy (no deviations). Radiotherapy techniques in this period evolved from 3D-conformal to IMRT and VMAT. In 23 patients electron beams were used. Results Median age was 63 years (range 41–88), the majority of patients were female (60%). Twenty three patients were > 75 years old. The TNM stages were I, II, IIIA, and IIIB in 18%, 40%, 15% and 27%, 58% of patients had N0 status. Concurrent mitomycin C and 5-fluoruracil-based chemotherapy was given in 63 patients (64%). Five-year overall survival (OS), disease free survival (DFS), locoregional control (LRC) and colostomy free survival (CFS) were 71%, 80%, 82%, and 82% for the whole group. Results in patients > 75 years of age were not statistically different from those in younger patients. With the introduction of more conformal techniques DFS did not change and toxicities decreased. Conclusion Real word treatment outcomes per disease stage were in line with what is reported in literature. Older patients should also be offered treatment with curative intent.

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Reduced radiation dose for elective nodal irradiation in node-negative anal cancer: back to the roots?

Abstract: Reducing the total irradiation dose to uninvolved nodal regions to 39.6 Gy in chemoradiation protocols for anal carcinoma was safe and effective, and a prospective evaluation in future clinical trials is warranted.

Cited by 8 publications

References 33 publications

Anal adenocarcinoma requires prophylactic inguinal nodal treatment: Results from a single Chinese institution

Anal adenocarcinoma requires prophylactic inguinal nodal treatment: Results from a single Chinese institution

Treatment results for patients with squamous-cell carcinoma of the anus, a single institution retrospective analysis

Treatment results for patients with squamous-cell carcinoma of the anus, a single institution retrospective analysis

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