Outcomes after intensity-modulated compared with 3-dimensional conformal radiotherapy with chemotherapy for squamous cell carcinoma of the anal canal

M. S. Agarwal, K. E. Hitchcock, C. G. Morris, T. J. George Jr, W. M. Mendenhall, R. A. Zlotecki

Abstract


Purpose   We report our institution’s treatment techniques, disease outcomes, and complication rates after radiotherapy for the management of anal canal carcinoma with intensity-modulated radiotherapy (imrt) and concurrent chemotherapy relative to prior cases managed with 3-dimensional conformal radiotherapy (3D-crt).

Methods   In a retrospective review of the medical records of 21 patients diagnosed with biopsy-proven stage i (23%), stage ii (27%), or stage iii (50%) squamous-cell carcinoma of the anal canal treated with curative chemotherapy and imrt between July 2009 and December 2014, patient outcomes were determined. Results for patients treated with 3D-crt by the same group were previously reported. The median initial radiation dose to the pelvic and inguinal nodes at risk was 45 Gy (range: 36–50.4 Gy), and the median total dose, including local anal canal primary tumour boost, was 59.4 Gy (range: 41.4–61.2 Gy). Patients received those doses over a median of 32 fractions (range: 23–34 fractions). Chemotherapy consisted of 2 cycles of concurrent fluorouracil–cisplatin (45%) or fluorouracil–mitomycin C (55%).

Results   Median follow-up was 3.1 years (range: 0.38–6.4 years). The mean includes a patient who died of septic shock at 38 days. The 3-year rates of overall survival, metastasis-free survival, locoregional control, and colostomy-free

survival were 95%, 100%, 100%, and 100% respectively. No patients underwent abdominoperitoneal resection after chemoradiotherapy or required diverting colostomy during or after treatment. Those outcomes compare favourably with the previously published series that used 3D-crt with or without brachytherapy in treating anal canal cancers. Of the 21 patients in the present series, 10 (48%) experienced acute grade 3, 4, or 5 toxicities related to treatment.

Conclusions   The recommended use of imrt with concurrent chemotherapy as an improvement over 3D-crt for management of anal canal carcinoma achieves a high probability of local control and colostomy-free survival without excessive risk for acute or late treatment-related toxicities.


Keywords


radiation oncology; anal carcinoma; intensity-modulated radiotherapy; 3-dimensional conformal radiotherapy

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DOI: http://dx.doi.org/10.3747/co.26.4311






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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)