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Intensity-modulated Radiation Therapy for Anal Cancer: Results From a Multi-Institutional Retrospective Cohort Study
Jason A Call1, Brendan M Prendergast, Lindsay G Jensen
1*Cancer Care Northwest, Spokane, WA #Department of Radiation Oncology, Mayo Clinic, Rochester, MN †Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL ‡Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA §Department of Radiation Medicine, Oregon Health & Science University, Portland, OR ∥Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY ¶Department of Radiation Oncology, The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ.
Objectives:
To assess toxicity and efficacy of intensity-modulated radiation therapy (IMRT) for anal cancer.
Methods:
Records of 152 patients were reviewed retrospectively from multiple institutions. Data on disease control and toxicity were collected as well as patient and treatment characteristics. Acute (<6 mo) and late (≥6 mo) severe toxicity (grade ≥3) were graded. Four patients were excluded due to the presence of metastatic disease or stage TX. Late toxicity data were available for 120 patients.
Results:
Median cumulative IMRT dose was 51.25 Gy (median, 28 fractions). All but 2 patients received chemotherapy. With median follow-up of 26.8 months, local control at 3 years was 87%, worse for patients with T3-T4 than T1-T2 disease on univariate analysis (79% vs. 90%; P=0.04). Regional control, distant control, and overall survival were 97%, 91%, and 87%, respectively, at 3 years. Nodal status was associated with regional control, distant control, and overall survival (P<0.01 for each). Most common severe acute toxicity was hematologic (41%), skin (20%), and gastrointestinal tract (11%). Two grade 5 toxicities occurred (hematologic and gastrointestinal tract). Severe late toxicity affected skin (1%) and gastrointestinal tract (3%).
Conclusions:
IMRT with chemotherapy resulted in excellent local control. Although T stage predicted worse local control, most T3-T4 disease was controlled with IMRT. Nodal status predicted regional and distant control and overall survival. Severe toxicity was acceptable.
