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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

Kaplan Meier estimates of overall survival (n = 64)
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Fig2: Kaplan Meier estimates of overall survival (n = 64)

Mentions: Sixty-four patients were evaluated at the first follow-up visit: 34 (54.0 %) had complete response and 30 patients had partial response at the first follow-up visit (median interval, 1.6 months; range, 0.4–5.7 months). Eighteen patients who were considered partial responders at first follow-up evaluation were considered complete responders at the following evaluations (up to 14.2 months after the end of treatment). The median interval between end of radiotherapy and end of follow-up was 22.9 months (range, 3.5–52.0 months). Forty-seven patients (73.4 %) experienced a complete response and 17 patients experienced recurrence after a median 5.4 months following the end of radiotherapy (range, 3.2–9.3 months): three patients had distant recurrence, one patient experienced both local and distant recurrence and 13 patients experienced local failure as first recurrence. Among these 13 patients, 11 were considered partial responders and two were considered complete responders at first evaluation, before diagnosis of disease progression. Eleven patients had to undergo salvage surgery consisting of abdomino-perineal resection: among them, seven were in complete remission, two experienced local failure, one experienced distant failure, and one experienced both local and distant failure. Overall, six patients experienced metastatic failure, and for three patients it was the only recurrence. Among the 17 patients who experienced local or distant recurrence, two patients did not receive concomitant chemotherapy and four patients had a modified chemotherapy regimen (eloxatine based regimen for three patients and capecitabine alone for one patient). Nine patients (14.1 %) died during follow-up, at a median 11.5 months (range, 5.4–28.7 months). One-year OS was 88.4 % (95 %CI [75.9 %–94.7 %]) and two-year OS was 85.6 % (95 %CI [71.1 %–93.0 %]) (Fig. 2). OS was significantly better for women than men (p = 0.0017) (Fig. 3). OS was not associated with age, tumour size, nodal status, break in treatment, concomitant chemotherapy or overall treatment time (longer or shorter than 56 days).Fig. 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)

Kaplan Meier estimates of overall survival (n = 64)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Kaplan Meier estimates of overall survival (n = 64)
Mentions: Sixty-four patients were evaluated at the first follow-up visit: 34 (54.0 %) had complete response and 30 patients had partial response at the first follow-up visit (median interval, 1.6 months; range, 0.4–5.7 months). Eighteen patients who were considered partial responders at first follow-up evaluation were considered complete responders at the following evaluations (up to 14.2 months after the end of treatment). The median interval between end of radiotherapy and end of follow-up was 22.9 months (range, 3.5–52.0 months). Forty-seven patients (73.4 %) experienced a complete response and 17 patients experienced recurrence after a median 5.4 months following the end of radiotherapy (range, 3.2–9.3 months): three patients had distant recurrence, one patient experienced both local and distant recurrence and 13 patients experienced local failure as first recurrence. Among these 13 patients, 11 were considered partial responders and two were considered complete responders at first evaluation, before diagnosis of disease progression. Eleven patients had to undergo salvage surgery consisting of abdomino-perineal resection: among them, seven were in complete remission, two experienced local failure, one experienced distant failure, and one experienced both local and distant failure. Overall, six patients experienced metastatic failure, and for three patients it was the only recurrence. Among the 17 patients who experienced local or distant recurrence, two patients did not receive concomitant chemotherapy and four patients had a modified chemotherapy regimen (eloxatine based regimen for three patients and capecitabine alone for one patient). Nine patients (14.1 %) died during follow-up, at a median 11.5 months (range, 5.4–28.7 months). One-year OS was 88.4 % (95 %CI [75.9 %–94.7 %]) and two-year OS was 85.6 % (95 %CI [71.1 %–93.0 %]) (Fig. 2). OS was significantly better for women than men (p = 0.0017) (Fig. 3). OS was not associated with age, tumour size, nodal status, break in treatment, concomitant chemotherapy or overall treatment time (longer or shorter than 56 days).Fig. 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