Helical tomotherapy with concurrent chemotherapy in the treatment of anal canal carcinoma: A review of clinical outcomes at a tertiary referral center.

Abstract

656 Background: We report the clinical outcomes of patients with anal carcinoma treated with helical tomotherapy (HT) IMRT and concurrent chemotherapy. Methods: From September 2005 to January 2013, 32 patients with squamous cell carcinoma of the anal canal received chemoradiation with HT planned in a consistent manner in parallel to the RTOG 0529 guidelines. Of the patients, 17 (53%) were T1-2, 13 (41%) were T3-T4, 15 (47%) were node positive, and 1 was M1 with para-aortic nodal metastases. There were 7 HIV positive and 3 renal transplant patients. All but 2 patients received 5-fluorouracil and mitomycin C. The median doses to the primary site, involved nodes, and uninvolved nodes were 54 Gy, 50.4 Gy, and 45 Gy, respectively. All acute and late toxicities were scored with the CTCAE v4.0. Results: Median follow-up was 31 months (range 10-97 months). Median length of treatment was 43 days. Twenty-two patients (69%) took a median of 3.5 break days. Acute grade 3-4 hematologic toxicity occurred in 27 patients (84%). There were no grade 4 gastrointestinal or dermatologic toxicities. Eight patients (25%) experienced grade 3 gastrointestinal and dermatologic toxicities. Twenty-one patients (66%) were hospitalized a total of 37 times during chemoradiation or within 90 days of therapy completion. Neutropenic fever was the most common reason for hospitalization, accounting for 30% of admissions. Thirty-one patients were followed for late toxicity with results as follows: 7 patients (23%) had grade 3 gastrointestinal toxicity, 1 patient (3%) had grade 3 dermatologic toxicity, and 3 patients (10%) had grade 3 sexual dysfunction. Nine patients (29%) developed pelvic insufficiency fractures, 5 requiring intervention. The 2-year progression-free and overall survivals were 97% and 97%, respectively. Two patients died; 1 from local progression and 1 from unrelated causes. Conclusions: HT delivering moderate radiation doses consistent with the RTOG 0529 guidelines and chemotherapy paired with aggressive, multidisciplinary management of acute and late toxicities effectively treat squamous cell carcinoma of the anal canal.