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French multicentre clinical evaluation of helical TomoTherapy for anal cancer in a cohort of 64 consecutive patients.

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)

Bottom Line: Median follow-up was 22.9 months.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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Hospital Haut-Lévêque, CHU Bordeaux, Pessac, France. veronique.vendrely@chu-bordeaux.fr.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Dose distribution on planning CT with Tomotherapy for the first plan of treatment (45 Gy) for a patient with anal cancer
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Fig1: Dose distribution on planning CT with Tomotherapy for the first plan of treatment (45 Gy) for a patient with anal cancer

Mentions: Median total dose was 59.4 Gy (range, 45.0–67.1 Gy) and median dose per fraction was 1.8 Gy (Fig. 1). Dosimetric parameters concerning PTV coverage and conformity index are summarized in Table 2 and results of dose volume histogram (DVH) analysis for OARs are reported in Table 3. Median overall treatment time (OTT) was 57 days (range, 35–113 days). Thirty patients experienced a treatment break of a mean duration of 5.9 days: in two centres, the treatment break was indicated only based on toxicity for 12 patients whereas in the third centre the break was prospectively planned for 18 patients. Chemotherapy was combined with radiotherapy for 57 patients (89.2 %) and consisted of cisplatin and 5-FU for 49 patients, mitomycine and 5-FU for three patients. For five patients, a combination of eloxatine and 5-FU (folfox regimen) or oral 5-FU in the form of capecitabine were prescribed because of cardiac or renal comorbidities (contra-indication for cisplatin). Seven patients did not receive any concomitant chemotherapy because of comorbidities and age.Table 2


French multicentre clinical evaluation of helical TomoTherapy for anal cancer in a cohort of 64 consecutive patients.

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)

Dose distribution on planning CT with Tomotherapy for the first plan of treatment (45 Gy) for a patient with anal cancer
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4554302&req=5

Fig1: Dose distribution on planning CT with Tomotherapy for the first plan of treatment (45 Gy) for a patient with anal cancer
Mentions: Median total dose was 59.4 Gy (range, 45.0–67.1 Gy) and median dose per fraction was 1.8 Gy (Fig. 1). Dosimetric parameters concerning PTV coverage and conformity index are summarized in Table 2 and results of dose volume histogram (DVH) analysis for OARs are reported in Table 3. Median overall treatment time (OTT) was 57 days (range, 35–113 days). Thirty patients experienced a treatment break of a mean duration of 5.9 days: in two centres, the treatment break was indicated only based on toxicity for 12 patients whereas in the third centre the break was prospectively planned for 18 patients. Chemotherapy was combined with radiotherapy for 57 patients (89.2 %) and consisted of cisplatin and 5-FU for 49 patients, mitomycine and 5-FU for three patients. For five patients, a combination of eloxatine and 5-FU (folfox regimen) or oral 5-FU in the form of capecitabine were prescribed because of cardiac or renal comorbidities (contra-indication for cisplatin). Seven patients did not receive any concomitant chemotherapy because of comorbidities and age.Table 2

Bottom Line: Median follow-up was 22.9 months.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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Hospital Haut-Lévêque, CHU Bordeaux, Pessac, France. veronique.vendrely@chu-bordeaux.fr.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus