Image-guided IMRT with simultaneous integrated boost as per RTOG 0529 for the treatment of anal cancer.

Abstract

AIM:

To report on clinical outcomes of simultaneous integrated boost intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy as per Radiation Therapy Oncology Group (RTOG) 0529 protocol in anal cancer patients.

METHODS:

Clinical stage T1-T4 N0-N3 anal cancer patients were submitted to concomitant chemoradiation. Patients with cT2N0 disease were prescribed 50.4 Gy/28 fractions to the gross tumor planning target volume (PTV) and 42 Gy/28 fractions to the elective nodal PTV. Patients staged as cT3-T4/N0-N3 were given 54 Gy/30 fractions to the macroscopic anal PTV, while clinical nodes were prescribed 50.4 Gy/30 fractions if <3 cm or 54 Gy/30 fractions if ≥3 cm; elective nodal PTV was prescribed 45 Gy/30 fractions. Two cycles of concomitant 5-fluorouracil and mitomycin C were planned for all patients. Oncological outcomes, acute and late toxicity profiles and pattern of failure were reported.

RESULTS:

The 3-year colostomy-free survival rate was 64% (95% CI 0.52-0.75). The 3-year local control, disease-free and overall survival rates were 69% (95% CI 0.57-0.79), 71% (95% CI 0.59-0.80) and 79% (95% CI 0.66-0.87), respectively. The cumulative incidence of colostomies was 15.1% (95% CI 8.15-23.88) at 24 months. The cumulative incidence of cancer-specific deaths was 16.4% (95% CI 8.60-26.47) at 36 months. Major acute toxicity consisted of hematological (G3-G4: 26%) and cutaneous (G3-G4: 16%) events. Only one case of ≥G3 late toxicity was documented.

CONCLUSIONS:

Simultaneous integrated boost IMRT and concurrent chemotherapy as per RTOG 0529 protocol seems to be safe and feasible with consistent oncological outcomes and a mild acute and late toxicity profile in anal cancer patients.

• Authors: Francesca Arcadipane, Pierfrancesco Franco, Manuela Ceccarelli, Gabriella Furfaro, Nadia Rondi, Elisabetta Trino, Stefania Martini, Giuseppe Carlo Iorio, Massimiliano Mistrangelo, Paola Cassoni, Patrizia Racca, Mario Morino, Umberto Ricardi
• Journal: Asia-Pacific journal of clinical oncology (Asia Pac J Clin Oncol) Vol. 14 Issue 3 Pg. 217-223 (Jun 2018) ISSN: 1743-7563 [Electronic] Australia
• PMID: 28856848 (Publication Type: Journal Article)
• Copyright: © 2017 John Wiley & Sons Australia, Ltd.

Topics

• Adult
• Aged
• Anus Neoplasms (diagnostic imaging, pathology, radiotherapy)
• Chemoradiotherapy (methods)
• Female
• Humans
• Male
• Middle Aged
• Radiotherapy, Image-Guided (methods)