Salvage surgery for locally recurrent anal cancer after intensity modulated radiation therapy with concurrent chemotherapy

Bogach, Jessica; Fenech, Darlene; Chu, William; Ashamalla, Shady; Ung, Yee C.; Taggar, Amandeep; Chan, Kelvin K.; Earle, Craig C.; Wong, C. Shun

doi:10.1016/j.ctarc.2020.100287

Cited by 3 publications

(4 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since 2011, at our institution anal cancer has been managed by a prospectively designed protocol of CRT consisting of doses-escalated intensity modulated radiotherapy (IMRT) according to increasing tumor stages without a planned RT break (11). Unfortunately despite IMRT, significant acute skin/perineal reactions and grade ≥3 hematologic toxicities and febrile neutropenia were observed.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk-adjusted chemoradiation according to human papilloma viral status for anal cancer: a pilot study

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background and purposeHPV-associated or positive (HPV+) anal cancer patients may have better outcome compared to those with HPV negative (HPV−) disease. We report a planned interim analysis of a prospective registry study that tailors chemoradiation (CRT) for anal cancer according to HPV status.Materials and methodsHPV+ patients received de-escalated radiation doses of 45, 50.4 and 55.8 Gy, while HPV− received 50.4, 55.8 and 63 Gy for T1, T2 and T3/T4 disease respectively. Chemotherapy consisted of a single dose of mitomycin-C and oral capecitabine on days of RT. All patients were planned by VMAT following CT, PET/CT and MR simulation. This cohort (n = 24) had a minimum 24-month follow-up. Disease free survival (DFS) and local failure rates (LFR) were compared with 180 patients managed by standard CRT (2 cycles of mitomycin-C and 5-fluorouracil, radiation doses 50.4-63 Gy based on T-category) from 2011-2018. Propensity score comparison was performed using a retrospective to prospective 2 to 1 match based on tumor size and N-category.ResultsIn the HPV+ cohort (n = 20), there were 2 local failures. Two of 4 HPV− patients failed locally. The 30-month DFS and LFR were 79% and 17% respectively. Similar DFS and LFR were observed in the retrospective (80% and 15% respectively) and matched patients (76% and 16% respectively). No grade ≥3 neutropenia and febrile neutropenia were observed in the registry cohort whereas 19% and 14% respectively were seen in the retrospective patients.ConclusionDe-escalation of CRT for HPV+ anal cancer may result in decreased acute toxicities and similar cancer outcomes compared to standard CRT.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Here we report results of a planned interim analysis after the initial cohort of 24 consecutive participants had a minimum follow up of 24 months. Patient outcomes were compared with our retrospective cohort of 180 patients treated since the introduction of IMRT as a standard in 2011 (11).…”

Section: Introductionmentioning

confidence: 99%

Risk-adjusted chemoradiation according to human papilloma viral status for anal cancer: a pilot study

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…[6,7] In recent years, with the development of radiotherapy technology, IMRT has replaced 3DCRT as the most common method of radiation therapy for prostate cancer for its conformable dose distribution which can reduce normal tissue toxicity. [1,3] The most common method for IMRT delivery for prostate cancer involves [5][6][7][8][9] fixed gantry positions with computer-generated, sliding-window multi-leaf collimator positions to modulate the dose to the prostate. [8][9][10] A more recent IMRT technique named volume modulated arc therapy HS and GH contributed equally to this work.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment of localized prostate cancer has been proven by clinical trial including hypo-fractionation radiation therapy (RT) dose escalation with Elective Nodal Irradiation and androgen deprivation therapy (ADT) combined with RT. [1][2][3][4][5] With the development of radiotherapy intensity modulated radiation therapy (IMRT), it has been widely used in prostate cancer. Radiation therapy related toxicity is associated with high total RT dose, shorter recovery time, and the volume of neighboring organs at risk (OAR) normal tissues (rectum, bowel, and bladder) ever in prostate-only RT.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of fixed field dynamic IMRT and VMAT techniques in simultaneous integrated boost radiotherapy of prostate cancer

Sun

Wang²,

Huang³

et al. 2022

Medicine

View full text Add to dashboard Cite

High-risk prostate cancer can take advantage of the combination of hypofractionated radiotherapy and pelvic conventional fraction radiotherapy. The comparison between fixed field dynamic IMRT and VMAT techniques can provide suggestions for clinical treatment. We selected 10 high-risk prostate cancer patients who received radiotherapy at the cancer center of Sun Yat-sen University from January 2016 to December 2019. The targets contained in prostate, seminal vesicles and pelvic lymph nodes. With the same prescription and optimized parameters, 9F, single-arc (1ARC) and double-arc (2ARC) treatment plans were developed. The dose distribution of the targets, OAR, MU, treatment time and gamma pass ratios of dose verification was compared. The D2% (69.37 ± 0.89) Gy, D50% (66.92 ± 0.63) Gy, HI (0.09 ± 0.02), and CI (0.83 ± 0.05) of PTV1 in 9F were slightly better than those of 1ARC which were (71.13 ± 1.21) Gy, (68.50 ± 0.76) Gy, (0.12 ± 0.02), (0.74 ± 0.07), except D98%, the difference was significant (P < .05). All dosimetry indices of PTV1 in 9F and 2ARC were close and have no significant differences (P > .05). The V95% (99.45 ± 0.78)% of PTV2 in 9F was slightly better than that in 1ARC (99.35 ± 1.28)%. The difference was significant (P < .05). All dosimetry indices of PTV2 in 9F and 2ARC were close and the difference was not significant (P > .05). The Dmean of the bladder and the V67.5 Gy of rectum between all three plans were similar. The Dmean of left and right femoral in 1ARC and 2ARC were lower than that in 9F, and the difference was significant (P < .05). Other dosimetry indices of OARs in 9F were lower than those in 1ARC and 2ARC, and much lower than 1ARC. The difference was significant (P < .05). Mean monitor units in 1ARC and 2ARC were fewer by 70.0% and 67.2% in comparison with 9F. The treatment mean time in 1ARC and 2ARC was shorter by 81.7% and 61% in comparison with 9F. Verification pass ratios of γ (3%/3 mm) were 97.8% (9F), 98.9% (1ARC) and 99.4% (2ARC) respectively. The difference was significant (P < .05). Compared with IMRT, VMAT improved delivery efficiency noticeably. Two arcs provided comparable tumor dosimetry coverage, but performed worse in dose sparing for bladder, rectum and small bowel. The IMRT plan was preferable to VMAT in prostate cancer simultaneous integrated boost radiotherapy.

show abstract

Anal carcinoma - exploring the epidemiology, risk factors, pathophysiology, diagnosis, and treatment

English

2024

World J Exp Med

View full text Add to dashboard Cite

Anal carcinoma is a relatively rare tumor that accounts for approximately 2% of gastrointestinal malignancies and less than 7% of anorectal cancers. Most anal tumors originate between the anorectal junction and the anal verge. Risk factors for the disease include human papillomavirus infection, human immunodeficiency virus, tobacco use, immunosuppression, female sex, and older age. The pathogenesis of anal carcinoma is believed to be linked to human papillomavirus-related inflammation, leading to dysplasia and progression to cancer. Squamous cell carcinoma is the most common type of anal tumor, with an annual incidence of approximately 1 to 2 per 100000 persons. Treatment regarding anal cancer has emerged over time. However, chemoradiation therapy remains the mainstay approach for early localized disease. Patients with metastatic disease are treated with systemic therapy, and salvage surgery is reserved for disease recurrence following chemoradiation. This article aims to provide background information on the epidemiology, risk factors, pathology, diagnosis, and current trends in the management of anal cancer. Future directions are briefly discussed.

show abstract

Salvage surgery for locally recurrent anal cancer after intensity modulated radiation therapy with concurrent chemotherapy

Cited by 3 publications

References 23 publications

Risk-adjusted chemoradiation according to human papilloma viral status for anal cancer: a pilot study

Risk-adjusted chemoradiation according to human papilloma viral status for anal cancer: a pilot study

Dosimetric comparison of fixed field dynamic IMRT and VMAT techniques in simultaneous integrated boost radiotherapy of prostate cancer

Anal carcinoma - exploring the epidemiology, risk factors, pathophysiology, diagnosis, and treatment

Contact Info

Product

Resources

About