Abstract
AimTo assess clinical outcomes of patients treated with a high-dose rate brachytherapy boost for anal canal cancer (ACC).MethodsFrom August 2005 to February 2013, 28 patients presenting an ACC treated by split-course external beam radiotherapy (EBRT) and HDR brachytherapy with or without chemotherapy in a French regional cancer center in Nice were retrospectively analyzed.ResultsMedian age was 60.6 years [34 – 83], 25 patients presented a squamous cell carcinoma and 3 an adenocarcinoma; 21 received chemotherapy. Median dose of EBRT was 45 Gy [43.2 – 52]. Median dose of HDR brachytherapy was 12 Gy [10 - 15] with a median duration of 2 days. Median overall treatment time was 63 days and median delay between EBRT and brachytherapy was 20 days. Two-year local relapse free, metastatic free, disease free and overall survivals were 83%, 81.9%, 71.8% and 87.7% respectively. Acute toxicities were frequent but not severe with mostly grade 1 toxicities: 37% of genito-urinary, 40.7% of gastro-intestinal and 3.7% of cutaneous toxicities. Late toxicities were mainly G1 (43.1%) and G2 (22%). Two-year colostomy-free survival was 75.1%, one patient had a definitive sphincter amputation.ConclusionHigh-dose rate brachytherapy for anal canal carcinoma as boost represents a feasible technique compared to low or pulsed-dose rate brachytherapy. This technique remains an excellent approach to precisely boost the tumor in reducing the overall treatment time.
Highlights
Anal canal carcinoma (ACC) is a rare disease with an incidence rate of less than 10 cases per 1 000 000 habitants in Europe [1], which has been considered as a life deteriorating even when cured because of sphincter amputation caused by historical surgical treatment
This study was aimed to assess clinical outcomes of patients treated with a HDR brachytherapy boost for anal canal cancer
All the patients presenting with a tumor involving no more than 2/3 of the anal canal circumference were eligible for brachytherapy boost
Summary
Anal canal carcinoma (ACC) is a rare disease with an incidence rate of less than 10 cases per 1 000 000 habitants in Europe [1], which has been considered as a life deteriorating even when cured because of sphincter amputation caused by historical surgical treatment. Conservative treatments for sphincter preservation in ACC have become a standard, even for large tumors. As proposed for numerous tumors (prostate [11] and cervical cancer [12]) HDR brachytherapy appears to be more and more used mainly because of radioprotection considerations, dose distribution optimization and shorter treatment time [13]. This study was aimed to assess clinical outcomes of patients treated with a HDR brachytherapy boost for anal canal cancer
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