A Ghareeb1,2, K Paramasevon1, P Mokool1, H van der Voet3, M Jha1. 1. Department of General Surgery, James Cook University Hospital , Middlesbrough , UK. 2. Institute of Genetic Medicine, Newcastle University, International Centre for Life , Newcastle upon Tyne , UK. 3. Cancer Services, James Cook University Hospital , Middlesbrough , UK.
Abstract
INTRODUCTION: The definitive treatment of anal cancer with chemoradiotherapy spares abdominoperineal resection for salvage treatment but carries a high burden of toxicity. Intensity-modulated radiation therapy has been implemented to reduce toxicity, reduce treatment breaks and improve survival. However, large and long-term studies are lacking. We aimed to investigate the toxicities and long-term survival of anal cancer patients treated with intensity-modulated radiation therapy at James Cook University Hospital, Middlesbrough. MATERIALS AND METHODS: We conducted a retrospective analysis of all patients with squamous cell anal cancer treated at James Cook University Hospital between July 2010 and April 2017. All patients were uniformly treated with intensity-modulated radiation therapy-based chemoradiation with curative intent. A subset of these patients was followed-up prospectively by an oncologist for acute and late toxicity. We calculated Kaplan-Meier estimates of survival statistics and compared our results with those of previous trials which used conventional radiotherapy. RESULTS: We studied 132 patients, including a toxicity subset of 64, for a median follow-up time of 43 months (range 3-84 months). Eleven patients (8.3%) underwent salvage abdominoperineal resection. Grade 3+ acute non-haematological, gastrointestinal, genitourinary and dermatological toxicity were found in 56.2%, 12.3%, 0% and 50.7% of the toxicity subset (n = 64). Median treatment duration was 37 days. Overall and colostomy-free survival at five years were 68.3% and 85.3%, respectively. Tumour size (P = 0.006) and age (P = 0.002) predicted shorter overall survival. CONCLUSIONS: Intensity-modulated radiation therapy probably reduces acute gastrointestinal and genitourinary toxicity compared with conventional radiotherapy, while resulting in similar overall and colostomy-free survival. We suggest that further dose escalation may improve survival in patients with T3/T4 tumours.
INTRODUCTION: The definitive treatment of anal cancer with chemoradiotherapy spares abdominoperineal resection for salvage treatment but carries a high burden of toxicity. Intensity-modulated radiation therapy has been implemented to reduce toxicity, reduce treatment breaks and improve survival. However, large and long-term studies are lacking. We aimed to investigate the toxicities and long-term survival of anal cancerpatients treated with intensity-modulated radiation therapy at James Cook University Hospital, Middlesbrough. MATERIALS AND METHODS: We conducted a retrospective analysis of all patients with squamous cell anal cancer treated at James Cook University Hospital between July 2010 and April 2017. All patients were uniformly treated with intensity-modulated radiation therapy-based chemoradiation with curative intent. A subset of these patients was followed-up prospectively by an oncologist for acute and late toxicity. We calculated Kaplan-Meier estimates of survival statistics and compared our results with those of previous trials which used conventional radiotherapy. RESULTS: We studied 132 patients, including a toxicity subset of 64, for a median follow-up time of 43 months (range 3-84 months). Eleven patients (8.3%) underwent salvage abdominoperineal resection. Grade 3+ acute non-haematological, gastrointestinal, genitourinary and dermatological toxicity were found in 56.2%, 12.3%, 0% and 50.7% of the toxicity subset (n = 64). Median treatment duration was 37 days. Overall and colostomy-free survival at five years were 68.3% and 85.3%, respectively. Tumour size (P = 0.006) and age (P = 0.002) predicted shorter overall survival. CONCLUSIONS: Intensity-modulated radiation therapy probably reduces acute gastrointestinal and genitourinary toxicity compared with conventional radiotherapy, while resulting in similar overall and colostomy-free survival. We suggest that further dose escalation may improve survival in patients with T3/T4 tumours.
Authors: Yi-Jen Chen; An Liu; Peter T Tsai; Nayana L Vora; Richard D Pezner; Timothy E Schultheiss; Jeffrey Y C Wong Journal: Int J Radiat Oncol Biol Phys Date: 2005-09-01 Impact factor: 7.038
Authors: Michael T Milano; Ashesh B Jani; Karl J Farrey; Carla Rash; Ruth Heimann; Steven J Chmura Journal: Int J Radiat Oncol Biol Phys Date: 2005-10-01 Impact factor: 7.038
Authors: Joseph K Salama; Loren K Mell; David A Schomas; Robert C Miller; Kiran Devisetty; Ashesh B Jani; Arno J Mundt; John C Roeske; Stanley L Liauw; Steven J Chmura Journal: J Clin Oncol Date: 2007-10-10 Impact factor: 44.544
Authors: Jaffer A Ajani; Kathryn A Winter; Leonard L Gunderson; John Pedersen; Al B Benson; Charles R Thomas; Robert J Mayer; Michael G Haddock; Tyvin A Rich; Christopher Willett Journal: JAMA Date: 2008-04-23 Impact factor: 56.272
Authors: Ramin Roohipour; Sujata Patil; Karyn A Goodman; Bruce D Minsky; W Douglas Wong; José G Guillem; Philip B Paty; Martin R Weiser; Heather B Neuman; Jinru Shia; Deborah Schrag; Larissa K F Temple Journal: Dis Colon Rectum Date: 2008-01-08 Impact factor: 4.585
Authors: Scott C Lester; Laura A McGrath; Rachael M Guenzel; Jenae C Quinn; Carolyn J Schultz; T Baron Bradley; Bret D Kazemba; Shima Ito; Christopher L Hallemeier Journal: Int J Part Ther Date: 2022-04-26