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Intensity-modulated radiotherapy (IMRT) in the treatment of squamous cell anal canal cancer: acute and early-late toxicity, outcome, and efficacy

Abstract

Purpose

To retrospectively review our experience on 84 patients with squamous cell anal canal cancer (SCAC) within 12 months after combined treatment with intensity-modulated RT (IMRT), in terms of acute and early-late toxicity, overall treatment time and interruptions, colostomy-free survival (CFS), and tumor response.

Methods

Acute gastrointestinal (GI), genitourinary (GU), and cutaneous (CU) toxicities were assessed according to Common Toxicity Criteria for Adverse Events (CTCAE) version 4.03. Early-late toxicity was scored using the Radiation Therapy Oncology Group (RTOG) late radiation morbidity scoring system. Tumor response was evaluated with response evaluation criteria in solid tumors (RECIST) v1.1.

Results

Acute toxicity for 84 subjects (100%): severe (≥ G3) GI and skin toxicity was observed in 4 (5%) and 19 patients (23%), respectively. Early-late toxicity for 73 subjects (87%): severe (≥ G3) GI and vulvo-vaginal toxicity was observed in 2 (3%) and 2 (3%) patients, respectively. No acute or early-late severe GU toxicity was reported. A treatment interruption occurred in 65 patients (77%). CFS was 96% (95% CI 89–99) at 6 months and 92% (95% CI 83–96) at 12 months. At 6 months complete response (CR), partial response (PR) and progressive disease (PD) was observed in 70 (83%), 3 (4%), and 7 patients (8%), respectively. At 12 months, CR was observed in 60 patients (81%); eleven patients (15%) experienced PD.

Conclusion

Our study showed an excellent clinical result and very low acute toxicity rates, confirming the IMRT as standard of care for curative treatment of anal cancer patients.

The current trial was registered with the number IEO N87/11

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Funding

This study was partially supported by Fondazione IEO-CCM, project title: “AXILL-ART: Biology-based radiotherapy volume definition for 1-2 macrometastatic sentinel lymph nodes without further dissection in breast cancer conservative surgery” and by the Italian Ministry of Health with Ricerca Corrente and 5 × 1000 funds.

Author information

All authors contributed to the study conception and design in terms of material preparation, data collection, and analysis. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Correspondence to Maria Alessia Zerella.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (research project entitled “Image guided radiotherapy in gastrointestinal malignancies” notified to the Ethical Committee of the IEO, Milan, Italy No. IEO N87/11) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Veronica Dell’Acqua and Alessia Surgo are the Co-first author.

Maria Cristina Leonardi and Barbara Alicja Jereczek-Fossa are the Co-last author.

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Dell’Acqua, V., Surgo, A., Arculeo, S. et al. Intensity-modulated radiotherapy (IMRT) in the treatment of squamous cell anal canal cancer: acute and early-late toxicity, outcome, and efficacy. Int J Colorectal Dis (2020). https://doi.org/10.1007/s00384-020-03517-x

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Keywords

  • Radiotherapy
  • Anal cancer
  • Chemotherapy
  • IMRT
  • Toxicity
  • Colostomy