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2015 ; 10
(ä): 170
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French multicentre clinical evaluation of helical TomoTherapy for anal cancer in
a cohort of 64 consecutive patients
#MMPMID26268888
Vendrely V
; Henriques de Figueiredo B
; Rio E
; Benech J
; Belhomme S
; Lisbona A
; Frison E
; Doussau A
; Nomikossoff N
; Mahé MA
; Kantor G
; Maire JP
Radiat Oncol
2015[Aug]; 10
(ä): 170
PMID26268888
show ga
PURPOSE/OBJECTIVES: To assess feasibility and toxicity of Helical TomoTherapy for
treating anal cancer patients. METHODS: From 2007 to 2011, 64 patients were
consecutively treated with TomoTherapy in three centres for locally advanced
squamous-cell anal carcinoma (T2?>?4 cm or N positive). Prescribed doses were 45
Gy to the pelvis including inguinal nodes and 59.4 Gy to the primary site and
involved nodes with fractions of 1.8 Gy, five days a week. A positional
Megavoltage Computed Tomography was performed before each treatment session. All
acute and late toxicities were graded according to Common Terminology Criteria
for Adverse Events version 3.0. Survival analysis was performed using the
Kaplan-Meier method. RESULTS: Median follow-up was 22.9 months. Fifty-four women
and 10 men were treated (median age: 62 years). Nineteen patients (29.7%) had T2,
16 patients (25.0%) T3, and 27 patients (42.2%) T4 tumours. Thirty-nine patients
(60.9%) had nodal involvement. Median tumour size was 45 mm (range, 10-110 mm).
Seven patients had a colostomy before treatment initiation. Fifty-seven patients
received concomitant chemotherapy (5-FU/cisplatin or 5-FU/mitomycin-based
therapy). Forty-seven patients (73.4 %) experienced a complete response, 13 a
partial response or local recurrence, and 11 had salvage surgery; among these,
six became complete responders, three experienced metastatic failure, and two
local failure. At least four patients experienced metastatic recurrence
(concomitant to a local failure for one patient). The two-year overall survival
was 85.6% (95 %CI [71.1%-93.0%]), and the one-year disease-free survival, and
colostomy-free survival were 68.7% (95 %CI [54.4%-79.4]), and 75.5% (95 %CI
[60.7%-85.3%]) respectively. Overall survival, disease-free survival and
colostomy free-survival were significantly better for women than men (p?=?0.002,
p?=?0.004, and p?=?0.002 respectively). Acute grade ?3 toxicity included
dermatologic (46.9% of patients), gastrointestinal (20.3%), and hematologic
(17.2%) toxicity. Acute grade 4 hematologic toxicity occurred in one patient. No
grade 5 event was observed. CONCLUSIONS: TomoTherapy for locally advanced anal
cancer is feasible. In our three centres of expertise, this technique appeared to
produce few acute gastrointestinal toxicities. However, high rates of
dermatologic toxicity were observed. The therapeutic efficacy was within the
range of expectations and similar to previous studies in accordance with the high
rates of locally advanced tumours and nodal involvement.