Squamous-cell carcinoma of the anus: progress in radiotherapy treatment

Glynne‐Jones, Rob; Tan, David; Hughes, Robert J.; Hoskin, Peter

doi:10.1038/nrclinonc.2015.218

Cited by 32 publications

(19 citation statements)

References 124 publications

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“…Because IMRT has demonstrated efficacy similar to that of 3DCRT 6,7 and has been shown to decrease acute toxicity, IMRT-based chemoradiation therapy is now the standard of care for the treatment of SCC of the anal canal. 21 As such, and because a future randomized trial comparing IMRT and 3DCRT is unlikely, this study offers further evidence supporting the use of IMRT.…”

Section: Discussionmentioning

confidence: 81%

Intensity‐modulated radiotherapy improves survival and reduces treatment time in squamous cell carcinoma of the anus: A National Cancer Data Base study

Elson

Kachnic

Kharofa

2018

Cancer

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BACKGROUND: Chemoradiation with 5-fluorouracil and mitomycin remains the standard of care for squamous cell carcinoma (SCC) of the anal canal. A prolonged treatment time is associated with inferior disease-specific outcomes. Radiation Therapy Oncology Group trial 0529 demonstrated decreased toxicity and fewer treatment breaks with intensity-modulated radiotherapy (IMRT), but this has not been assessed in a randomized trial. Using data from the National Cancer Data Base (NCDB), this study evaluated the impact of IMRT on treatment time and survival in anal SCC. METHODS: The NCDB was used to identify patients with anal cancer from 2004 to 2013. The included patients were those with stage I to III squamous cell cancer of the anal canal who had received definitive chemoradiation by IMRT or 3-dimensional conformal radiation therapy (3DCRT). Statistical analyses were performed with logistic regression, Kaplan-Meier analysis, Cox proportional hazards analysis, and propensity score-matched analysis. RESULTS: Of 6814 patients, 57.4% were treated with 3DCRT, whereas 42.6% received IMRT. Patients receiving IMRT had a reduced risk of a long treatment time in a multivariate analysis (P < .001). The 5-year overall survival (OS) rates with IMRT and 3DCRT were 80.8% and 78.9%, respectively (P = .0036). According to a propensity analysis, patients receiving IMRT had improved OS (P = .039) and a reduced risk of a long treatment time (P < .0001) in a multivariate analysis. CONCLUSIONS: IMRT use was associated with significantly reduced overall treatment time and improved survival in comparison with 3DCRT. It is important to note that NCDB data are not as robust as randomized data. However, these results further support the use of IMRT as part of sphincter-preserving therapy for the anal canal.

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Section: Discussionmentioning

confidence: 81%

Intensity‐modulated radiotherapy improves survival and reduces treatment time in squamous cell carcinoma of the anus: A National Cancer Data Base study

Elson

Kachnic

Kharofa

2018

Cancer

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“…Combined RT-CHT in a concomitant setting is the standard of cancer for anal cancer patients [ 11 ]. In Europe, split-course high-dose RT was mostly chosen as a treatment option following established seminal works [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, oncological results in terms of both local control (LC) colostomy-free (CFS) and overall survival (OS) seems promising with this treatment strategy [ 9 , 10 ]. In anal cancer patients, macroscopic primary and nodal disease and elective volumes are treated to different total nominal doses [ 11 ]. In the sequential boost approach (SeqB), this can be achieved through the progressive boosting of selected target regions harboring the macroscopic disease [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Comparing simultaneous integrated boost vs sequential boost in anal cancer patients: results of a retrospective observational study

et al. 2018

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BackgroundTo evaluate clinical outcomes of simultaneous integrated boost (SIB) - intensity modulated radiotherapy (RT) in patients with non metastatic anal cancer compared to those of a set of patients treated with 3-dimensional conformal RT and sequential boost (SeqB).MethodsA retrospective cohort of 190 anal cancer patients treated at 3 academic centers with concurrent chemo-RT employing either SIB or SeqB was analysed. The SIB-group consisted of 87 patients, treated with 2 cycles of Mitomycin (MMC) and 5-Fluorouracil (5FU) using SIB-IMRT delivering 42-45Gy/28–30 fractions to the elective pelvic lymph nodes and 50.4-54Gy/28-30fractions to the primary tumor and involved nodes, based on pre-treatment staging. The SeqB group comprised 103 patients, treated with MMC associated to either 5FU or Capecitabine concurrent to RT with 36 Gy/20 fractions to a single volume including gross tumor, clinical nodes and elective nodal volumes and a SeqB to primary tumor and involved nodes of 23.4 Gy/13 fractions. We compared colostomy-free survival (CFS), overall survival (OS) and the cumulative incidence of colostomy for each radiation modality. Cox proportional-hazards model addressed factors influencing OS and CFS.ResultsMedian follow up was 34 (range 9–102) and 31 months (range 2–101) in the SIB and SeqB groups. The 1- and 2-year cumulative incidences of colostomy were 8.2% (95%CI:3.6–15.2) and 15.0% (95%CI:8.1–23.9) in the SIB group and 13.9% (95%CI: 7.8–21.8) and 18.1% (95%CI:10.8–27.0) in the SeqB group. Two-year CFS and OS were 78.1% (95%CI:67.0–85.8) and 87.5% (95%CI:77.3–93.3) in the SIB group and 73.5% (95%CI:62.6–81.7) and 85.4% (95%CI:75.5–91.6) in the SeqB, respectively. A Cox proportional hazards regression model highlighted an adjusted hazard ratio (AdjHR) of 1.18 (95%CI: 0.67–2.09;p = 0.560), although AdjHR for the first 24 months was 0.95 (95%CI: 0.49–1.84;p = 0.877) for the SIB approach.ConclusionsSIB-based RT provides similar clinical outcomes compared to SeqB-based in the treatment of patients affected with non metastatic anal cancer.

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“…The American clinical practice guidelines, National Comprehensive Cancer Network (NCCN), recommend that PET/CT should be considered for RT planning [ 9 ]. Ideally CT, MRI and PET would be co-registered and used for target volume definition, with PET aiding tumor localization and MRI aiding tumor border delineation [ 10 ]. In practice, even though all modalities may be used during staging and description of tumor extent, the target volume delineator may be presented with PET-CT, MR-CT, or CT only.…”

Section: Introductionmentioning

confidence: 99%

Target volume delineation of anal cancer based on magnetic resonance imaging or positron emission tomography

et al. 2017

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PurposeTo compare target volume delineation of anal cancer using positron emission tomography (PET) and magnetic resonance imaging (MRI) with respect to inter-observer and inter-modality variability.MethodsNineteen patients with anal cancer undergoing chemoradiotherapy were prospectively included. Planning computed tomography (CT) images were co-registered with 18F–fluorodexocyglucose (FDG) PET/CT images and T2 and diffusion weighted (DW) MR images. Three oncologists delineated the Gross Tumor Volume (GTV) according to national guidelines and the visible tumor tissue (GTVT). MRI and PET based delineations were evaluated by absolute volumes and Dice similarity coefficients.ResultsThe median volume of the GTVs was 27 and 31 cm3 for PET and MRI, respectively, while it was 6 and 11 cm3 for GTVT. Both GTV and GTVT volumes were highly correlated between delineators (r = 0.90 and r = 0.96, respectively). The median Dice similarity coefficient was 0.75 when comparing the GTVs based on PET/CT (GTVPET) with the GTVs based on MRI and CT (GTVMRI). The median Dice coefficient was 0.56 when comparing the visible tumor volume evaluated by PET (GTVT_PET) with the same volume evaluated by MRI (GTVT_MRI). Margins of 1–2 mm in the axial plane and 7–8 mm in superoinferior direction were required for coverage of the individual observer’s GTVs.ConclusionsThe rather good agreement between PET- and MRI-based GTVs indicates that either modality may be used for standard target delineation of anal cancer. However, larger deviations were found for GTVT, which may impact future tumor boost strategies.

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Squamous-cell carcinoma of the anus: progress in radiotherapy treatment

Cited by 32 publications

References 124 publications

Intensity‐modulated radiotherapy improves survival and reduces treatment time in squamous cell carcinoma of the anus: A National Cancer Data Base study

Intensity‐modulated radiotherapy improves survival and reduces treatment time in squamous cell carcinoma of the anus: A National Cancer Data Base study

Comparing simultaneous integrated boost vs sequential boost in anal cancer patients: results of a retrospective observational study

Target volume delineation of anal cancer based on magnetic resonance imaging or positron emission tomography

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