Abstract
BackgroundConcurrent chemotherapy and radiation therapy is the preferred standard of care for patients with anal cancer. Several studies have suggested a benefit of intensity-modulated radiation therapy (IMRT) compared with 3D-conformal radiation (3D-CRT) regarding acute toxicity. This study evaluates outcome and toxicity of patients undergoing IMRT/Tomotherapy or 3D-CRT at our institution.MethodsA cohort of 105 anal cancer patients was treated with chemoradiation or radiation alone (16.2%) between January 2000 and December 2011. 37 patients received 3D-CRT while 68 patients were treated with IMRT. Follow-up exams were performed every 3 to 6 months for a minimum of 3 years and then annually.ResultsMedian follow-up was 41.4 months (2.8 – 158.4). Overall survival (OS), Progression-free survival (PFS) and local control (LC) at 3 years was 70.3%, 66.5%, 78.3% in the 3D-CRT group and 82.9%, 66.5%, 75.3% in the IMRT group without statistically significant difference. 3-year Colostomy-free survival (CFS) was 85.7% in the IMRT/Tomotherapy group and 91.8% in the 3D-CRT group (p = 0.48). No grade 4 toxicity was found in both groups. Severe (G2/3) acute skin toxicity (94.6% vs. 63.2%; p < 0.001) and acute gastrointestinal toxicity rate (67.6% vs. 47.1%; p = 0.03) was significantly higher with 3D-CRT compared to IMRT/Tomotherapy.ConclusionThe use of IMRT can reduce acute severe side effects of the skin and gastrointestinal tract but did not demonstrate improved results regarding OS, PFS, LC and CFS.
Highlights
Concurrent chemotherapy and radiation therapy is the preferred standard of care for patients with anal cancer
The cohort of 105 patients treated by intensity-modulated radiation therapy (IMRT)/Tomotherapy or 3D-conformal radiation (3D-CRT) showed no significant differences regarding patient and tumour characteristics except for a higher proportion of women in the 3D-CRT group
Concerning the follow-up examination imaging showed 64 (60.9%) complete remissions (CR), 5 (4.8%) partial remissions (PR) and 5 (4.8%) patients with stable disease (SD) in both treatment groups. 12 patients in the 3D-CRT group and 21 patients in the IMRT/Tomotherapy group developed progressive disease (PD), 8/13 of them a local progression. 3/7 patients relapsed with distant metastases, 1/1 presented with systemic and local relapse
Summary
Concurrent chemotherapy and radiation therapy is the preferred standard of care for patients with anal cancer. The 5 year disease-free survival (DFS) of 67.8% and 5 year overall survival (OS) of 78.3% were achieved at the cost of a high incidence of grade 3 and 4 toxicity [5]. At the department of radiation oncology, University Hospital Heidelberg, and at the department of radiation oncology at the German Cancer Research Center, Heidelberg, IMRT for radiation therapy for anal cancer patients was introduced during 2003–2004. This retrospective analysis reports on the efficacy and toxicity of anal cancer patients undergoing 3D-conformal radiation (3D-CRT) or IMRT/Tomotherapy at our institution
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