Stephen R Thompson1,2, Isabel S Y Lee1, Susan Carroll3, Sarah Bishop1, Philip Douglas, Francis Lam4, Chris Brown5, Janet Williams1, David Goldstein2,6. 1. Department of Radiation Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia. 2. Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. 3. Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 4. Department of Colorectal Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia. 5. National Health and Medical Research Council, Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia. 6. Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: Loco-regional failure is the predominant cause of death in anal squamous cell carcinoma. We assessed patterns of loco-regional recurrence to determine the impact of radiotherapy (RT) volumes on patient outcome. METHODS: Retrospective clinical study, including patients treated curatively with RT or chemo-radiotherapy between 1994 and 2007. RT fields/volumes were reviewed and compared with patterns of failure. Patients were classified as having whole pelvic radiotherapy (WPRT) if RT extended to L5/S1 or lower pelvic radiotherapy (LPRT) if it extended to the lower sacroiliac joints or below. Patients with negative inguinal nodes either underwent prophylactic inguinal radiotherapy (PIRT) or had inguinal observation (IO). Patterns of failure were compared. RESULTS: Twenty-seven patients (53%) had WPRT and 24 (47%) had LPRT. Forty-two patients had negative inguinal nodes: 29 (69%) had PIRT and 13 (31%) had IO. Median follow-up was 5.8 years. Twelve regional failures occurred in eight patients: three pelvic, one inguinal and four pelvic and inguinal. All patients with regional failure died of disease. Pelvic nodal failure was 7.7% in N0 and 33% in N1-3 patients (P = 0.012). There was no difference in pelvic regional failure between WPRT and LPRT (11% versus 16%, P = 0.64). There was only one possible regional failure above LPRT in this group (4%). Inguinal failure was 0% in the PIRT group compared with 23% in IO group (P = 0.009). CONCLUSION: There was no difference in pelvic regional failure between WPRT and LPRT. LPRT is likely to be safe in N0 patients. Inguinal nodes should be treated in all patients.
BACKGROUND: Loco-regional failure is the predominant cause of death in anal squamous cell carcinoma. We assessed patterns of loco-regional recurrence to determine the impact of radiotherapy (RT) volumes on patient outcome. METHODS: Retrospective clinical study, including patients treated curatively with RT or chemo-radiotherapy between 1994 and 2007. RT fields/volumes were reviewed and compared with patterns of failure. Patients were classified as having whole pelvic radiotherapy (WPRT) if RT extended to L5/S1 or lower pelvic radiotherapy (LPRT) if it extended to the lower sacroiliac joints or below. Patients with negative inguinal nodes either underwent prophylactic inguinal radiotherapy (PIRT) or had inguinal observation (IO). Patterns of failure were compared. RESULTS: Twenty-seven patients (53%) had WPRT and 24 (47%) had LPRT. Forty-two patients had negative inguinal nodes: 29 (69%) had PIRT and 13 (31%) had IO. Median follow-up was 5.8 years. Twelve regional failures occurred in eight patients: three pelvic, one inguinal and four pelvic and inguinal. All patients with regional failure died of disease. Pelvic nodal failure was 7.7% in N0 and 33% in N1-3 patients (P = 0.012). There was no difference in pelvic regional failure between WPRT and LPRT (11% versus 16%, P = 0.64). There was only one possible regional failure above LPRT in this group (4%). Inguinal failure was 0% in the PIRT group compared with 23% in IO group (P = 0.009). CONCLUSION: There was no difference in pelvic regional failure between WPRT and LPRT. LPRT is likely to be safe in N0 patients. Inguinal nodes should be treated in all patients.
Authors: Kyung Su Kim; Kwang-Ho Cheong; Kyubo Kim; Taeryool Koo; Hyeon Kang Koh; Ji Hyun Chang; Ah Ram Chang; Hae Jin Park Journal: Sci Rep Date: 2021-02-02 Impact factor: 4.379
Authors: Kyung Su Kim; Ah Ram Chang; Kyubo Kim; Hyeon Kang Koh; Won Il Jang; Hae Jin Park; Ji Hyun Chang; Mi-Sook Kim Journal: Br J Radiol Date: 2019-12-17 Impact factor: 3.039