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Radiochemotherapie des Analkarzinoms

Aktuelles zur Zielvolumen − Definition

Radiochemotherapy of anal cancer

Current data on target volumes − definition

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coloproctology Aims and scope

Zusammenfassung

Durch die Implementierung der intensitätsmodulierten Radiotherapie (IMRT) in das Gesamtkonzept der Radiochemotherapie des Analkarzinoms kann die Verträglichkeit der Behandlung entscheidend verbessert werden. Allerdings setzen moderne Techniken wie die IMRT eine exakte Bildgebung, am besten mittels FDG-PET-CT, und eine standardisierte, qualitätsgesicherte Zielvolumendefinition voraus. Grundsätzlich sollen neben dem Primärtumor einschließlich befallener Lymphknotenstationen zusätzlich elektiv folgende Zielgebiete erfasst werden: Mesorektum, Präsakralraum, iliakal-interne Lymphknoten, Fossa ischiorectalis, obturatorische Lymphknoten, iliakal-externe Lymphknoten und inguinale Lymphknoten. Die Gesamtdosis der IMRT soll an den elektiven Lymphknotengruppen 45 Gy, an den befallenen Lymphknoten 50,4–54 Gy und am Primärtumor 50,4–54 Gy (T1–2) bzw. 54–59,4 Gy (>T2) betragen.

Abstract

The implementation of intensity modulated radiation therapy (IMRT) in the total concept of radiochemotherapy for anal cancer means that tolerance of the treatment can be decisively improved. However, modern techniques such as IMRT require an exact imaging procedure preferentially using fluorodeoxyglucose positron emission tomography computed tomography (FDG-PET-CT) and a standardized, quality assurance defined target volume. The following elective target areas should also principally be included in addition to the primary tumor together with affected lymph node locations: mesorectum, presacral space, internal iliac lymph nodes, ischiorectal fossa, obturator crest lymph nodes, external iliac lymph nodes and inguinal lymph nodes. The total dose of IMRT should be 45 Gy for elective lymph nodes, 50.4-54 Gy for positive lymph nodes and 50.4-54 Gy for T1-2 and 54–59.4 Gy for primary tumors larger than T2.

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Literatur

  1. (o A) (1996) Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 348(9034):1049–1054

  2. Ajani JA et al (2008) Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA 299(16):1914–1921

    Article  PubMed  CAS  Google Scholar 

  3. Anderson C et al (2007) PET-CT fusion in radiation management of patients with anorectal tumors. Int J Radiat Oncol Biol Phys 69(1):155–162

    Article  PubMed  Google Scholar 

  4. Bannas P et al (2011) Contrast-enhanced [(18)F]fluorodeoxyglucose-positron emission tomography/computed tomography for staging and radiotherapy planning in patients with anal cancer. Int J Radiat Oncol Biol Phys 81(2):445–451

    Article  PubMed  Google Scholar 

  5. Bartelink H et al (1997) Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 15(5):2040–2049

    PubMed  CAS  Google Scholar 

  6. Cotter SE et al (2006) FDG-PET/CT in the evaluation of anal carcinoma. Int J Radiat Oncol Biol Phys 65(3):720–725

    Article  PubMed  Google Scholar 

  7. Flam M et al (1996) Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 14(9):2527–2539

    PubMed  CAS  Google Scholar 

  8. Gerard JP et al (2001) Management of inguinal lymph node metastases in patients with carcinoma of the anal canal: experience in a series of 270 patients treated in Lyon and review of the literature. Cancer 92(1):77–84

    Article  PubMed  CAS  Google Scholar 

  9. Grabenbauer GG et al (2005) Tumor site predicts outcome after radiochemotherapy in squamous-cell carcinoma of the anal region: long-term results of 101 patients. Dis Colon Rectum 48(9):1742–1751

    Article  PubMed  Google Scholar 

  10. Hodges JC et al (2009) Intensity-modulated radiation therapy for the treatment of squamous cell anal cancer with para-aortic nodal involvement. Int J Radiat Oncol Biol Phys 75(3):791–794

    Article  PubMed  Google Scholar 

  11. Krengli M et al (2010) FDG-PET/CT imaging for staging and target volume delineation in conformal radiotherapy of anal carcinoma. Radiat Oncol 5:10

    Article  PubMed  Google Scholar 

  12. Menkarios C et al (2007) Optimal organ-sparing intensity-modulated radiation therapy (IMRT) regimen for the treatment of locally advanced anal canal carcinoma: a comparison of conventional and IMRT plans. Radiat Oncol 2:41

    Article  PubMed  Google Scholar 

  13. Myerson RJ et al (2009) Elective clinical target volumes for conformal therapy in anorectal cancer: a radiation therapy oncology group consensus panel contouring atlas. Int J Radiat Oncol Biol Phys 74(3):824–830

    Article  PubMed  Google Scholar 

  14. Ng M et al (2012) Australasian Gastrointestinal Trials Group (AGITG) Contouring atlas and planning guidelines for intensity-modulated radiotherapy in anal cancer. Int J Radiat Oncol Biol Phys

  15. Papillon J (1974) Radiation therapy in the management of epidermoid carcinoma of the anal region. Dis Colon Rectum 17(2):181–187

    Article  PubMed  CAS  Google Scholar 

  16. Salama JK et al (2007) Concurrent chemotherapy and intensity-modulated radiation therapy for anal canal cancer patients: a multicenter experience. J Clin Oncol 25(29):4581–4586

    Article  PubMed  CAS  Google Scholar 

  17. Schwarz JK et al (2008) Tumor response and survival predicted by post-therapy FDG-PET/CT in anal cancer. Int J Radiat Oncol Biol Phys 71(1):180–186

    Article  PubMed  Google Scholar 

  18. Sveistrup J et al (2011) Positron emission tomography/computed tomography in the staging and treatment of anal cancer. Int J Radiat Oncol Biol Phys 83(1):134−141

    Article  PubMed  Google Scholar 

  19. Wright JL et al (2010) Squamous cell carcinoma of the anal canal: patterns and predictors of failure and implications for intensity-modulated radiation treatment planning. Int J Radiat Oncol Biol Phys 78(4):1064–1072

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Radioonkologie und Strahlentherapie, Klinikum Coburg, Ketschendorferstr. 33, 96450, Coburg, Deutschland

    G.G. Grabenbauer

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  1. G.G. Grabenbauer
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Correspondence to G.G. Grabenbauer.

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Dieser Beitrag wurde erstpubliziert in Onkologe (2012) 18:672–677.

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Grabenbauer, G. Radiochemotherapie des Analkarzinoms. coloproctology 35, 177–181 (2013). https://doi.org/10.1007/s00053-013-0374-0

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  • DOI: https://doi.org/10.1007/s00053-013-0374-0

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