Accelerated radiotherapy in the treatment of anal squamous cell carcinoma – a single institution retrospective evaluation

Česká verzia

Authors: Z. Pechačová ¹; R. Lohynská ²; Š. Šantrůčková ¹; A. Šubrt ¹; T. Drbohlavová ¹; M. Pála ¹
Authors place of work: Ústav radiační onkologie 1. LF UK a FN Bulovka, Praha ¹; Onkologická klinika 1. LF UK a FTN Praha ²
Published in the journal: Klin Onkol 2024; 38(5): 335-344
Category: Original Articles
doi: https://doi.org/10.48095/ccko2024335

Summary

Background: The goal of treatment for anal squamous cell carcinoma (ASCC) is to preserve a functional anal sphincter and maintain the best quality of life. Surgical excision is reserved only for very early stages, and concomitant chemoradiotherapy (CHRT) is usually used in the treatment of ASCC. The aim of the study is a retrospective analysis of a group of patients with ASCC treated with CHRT using accelerated radiotherapy at the Institute of Radiation Oncology of Bulovka University Hospital in Prague (IRO BUH). Patients and methods: Between 2014 and 2022, 73 patients with ASCC underwent definitive CHRT. Patients were treated with accelerated radiotherapy in 25 fractions – to the tumor and affected lymph nodes at 2.3 Gy to a dose of 57.5 Gy and to the area of the lymphatics at 1.8 Gy to a dose of 45 Gy. Concomitant chemotherapy mitomycin + 5-fluorouracil, later mitomycin + capecitabine was administered. Results: A total of 64 (87.7%) patients underwent CHRT, in the remaining 9 (12.3%) cases only radiotherapy was applied. The 2- and 5-year overall survival rates were 85.8% and 76.3%, disease-free survival 88.0% and 86.3%, local control 91.9% and 91.9%, and colostomy-free interval 68.5% and 68.5%, respectively. The median of these parameters was not reached. Acute toxicity grade G3–4 was reported in 51 (69.8%) patients, late toxicity G3–4 was detected in 10 (13.7%) cases. No grade 5 toxicity occurred. Conclusion: Accelerated radiotherapy in the treatment of ASCC resulted in favorable disease control but was burdened with significant toxicity.

Keywords:

side effects – radiotherapy – concurrent chemoradiotherapy – anal cancer – treatment effectiveness

Zdroje

1. Systém pro vizualizaci onkologických dat. Epidemiologie zhoubných nádorů v České republice. [online]. Dostupné z: http: //www.svod.cz.

2. Šlampa P. Radiační onkologie. Praha: Maxdorf 2021.

3. Lohynská R. Anální spinocelulární karcinom. Praha: Maxdorf 2022.

4. Věstník Ministerstva zdravotnictví České republiky 2/2016. Národní radiologické standardy – radiační onkologie. [online]. Dostupné z: https: //mzd.gov.cz/wp-content/uploads/wepub/11347/36103/V%C4%9Bstn%C3%ADk%20MZ%20%C4%8CR%202-2016.pdf.

5. Linkos. Modrá kniha České onkologické společnosti, 30. aktualizace. [online]. Dostupné z: https: //www.linkos.cz/lekar-a-multidisciplinarni-tym/personalizovana-onkologie/modra-kniha-cos/aktualni-vydani-modre- knihy/.

6. Winkler R. Multimodality treatment of anal cancer. Experiences in 142 patients. Klin Onkol 1999; 12 (Suppl 1999): 8.

7. Ajani JA, Winter KA, Gunderson LL et al. Prognostic factors derived from a prospective database dictate clinical biology of anal cancer: the intergroup trial (RTOG 98-11). Cancer 2010; 116 (17): 4007–4013. doi: 10.1002/cncr.25188.

8. Joiner MC, van der Kogel A. Basic clinical radiobiology, 5th edition. CRC Press/Taylor&Francis Group 2019.

9. Lohynská R, Jirkovská M, Krátká Z. Časový faktor v radikální radioterapii nádorů hlavy a krku. Postgrad Med 2020; 2: 115–120.

10. Glynne-Jones R, Meadows H, Wan S et al. EXTRA – a multicenter phase II study of chemoradiation using a 5 day per week oral regimen of capecitabine and intravenous mitomycin C in anal cancer. Int J Radiat Oncol Biol Phys 2008; 72 (1): 119–126. doi: 10.1016/j.ijrobp. 2007.12.012.

11. Peixoto RD, Wan DD, Schellenberg D et al. A comparison between 5-fluorouracil/mitomycin and capecitabine/mitomycin in combination with radiation for anal cancer. J Gastrointest Oncol 2016; 7 (4): 665–672. doi: 10.21037/jgo.2016.06.04.

12. Goodman KA, Julie D, Cercek A et al. Capecitabine with mitomycin reduces acute hematologic toxicity and treatment delays in patients undergoing definitive chemoradiation using intensity modulated radiation therapy for anal cancer. Int J Radiat Oncol Biol Phys 2017; 98 (5): 1087–1095. doi: 10.1016/j.ijrobp.2017.03.022.

13. Lohynská R, Pechačová Z. Capecitabine in the treatment of anal squamous cell carcinoma. Klin Onkol 2022; 35 (1): 38–43. doi: 10.48095/ccko202238.

14. National Comprehensive Cancer Network. Anal carcinoma, version 1.2024. [online]. Dostupné z: https: //www.nccn.org.

15. Lohynská R, Pechačová Z. New approaches in palliative systemic therapy of anal sqamous cell carcinoma. Klin Onkol 2022; 35 (3): 190–194. doi: 10.48095/ccko2022190.

16. Lohynská R, Nýdlová A, Drbohlavová T et al. Haematotoxicity in IMRT/VMAT curatively treated anal cancer. Klin Onkol 2020; 33 (4): 288–294. doi: 10.14735/amko2020288.

17. Lohynska R, Mazana E, Novakova-Jiresova A et al. Improved survival in patients with FDG-PET/CT-based radiotherapy treatment planning for squamous cell anal cancer. Neoplasma 2020; 67 (5): 1157–1163. doi: 10.4149/neo_2020_191229N1350.

18. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31 (5): 1341–1346. doi: 10.1016/0360-3016 (95) 00060-C.

19. Martenson JA Jr, Gunderson LL. External radiation therapy without chemotherapy in the management of anal cancer. Cancer 1993; 71 (5): 1736–1740. doi: 10.1002/1097-0142 (19930301) 71: 5<1736:: aid-cncr2820710506>3.0.co; 2-f.

20. Ortholan C, Ramaioli A, Peiffert D et al. Anal canal carcinoma: early-stage tumors < or =10 mm (T1 or Tis): therapeutic options and original pattern of local failure after radiotherapy. Int J Radiat Oncol Biol Phys 2005; 62 (2): 479–485. doi: 10.1016/j.ijrobp.2004.09.060.

21. Youssef I, Osborn V, Lee A et al. Survival benefits and predictors of use of chemoradiation compared with radiation alone for early stage (T1-T2N0) anal squamous cell carcinoma. J Gastrointest Oncol 2019; 10 (4): 616–622. doi: 10.21037/jgo.2019.02.06.

22. Franco P, De Bari B, Arcadipane F et al. Comparing simultaneous integrated boost vs sequential boost in anal cancer patients: results of a retrospective observational study. Radiat Oncol 2018; 13 (1): 172. doi: 10.1186/s13014-018-1124-9.

23. Rotondi M, Facondo G, Mossa S et al. Comparative analysis of toxicity in patients with anal cancer undergoing definitive simultaneous integrated boost (SIB) or sequential integrated boost (SeqB) radiotherapy. Int J Colorectal Dis 2023; 38 (1): 125. doi: 10.1007/s00384-023-04411-y.

24. Milano MT, Jani AB, Farrey KJ et al. Intensity-modulated radiation therapy (IMRT) in the treatment of anal cancer: toxicity and clinical outcome. Int J Radiat Oncol Biol Phys 2005; 63 (2): 354–361. doi: 10.1016/j.ijrobp.2005.02.030.

25. Untiedt S, Rolf D, Scobioala S et al. Impact of dose escalation on colostomy-free survival and treatment outcome in squamous cell anal carcinoma. Strahlenther Onkol 2023; 199 (8): 749–760. doi: 10.1007/s00066-023-02056-y.