Impact of dose escalation on colostomy-free survival and treatment outcome in squamous cell anal carcinoma.
Strahlenther Onkol
; 199(8): 749-760, 2023 08.
Article
en En
| MEDLINE
| ID: mdl-36862155
ABSTRACT
PURPOSE:
Primary radiochemotherapy (RCT) constitutes the standard of care for early- and advanced-stage anal carcinoma. This retrospective study investigates the impact of dose escalation on colostomy-free survival (CFS), overall survival (OS), locoregional control (LRC), progression-free survival (PFS), and acute and late toxicities in patients with squamous cell anal cancer.METHODS:
Considered were the outcomes of 87 patients with anal cancer treated with radiation/RCT between May 2004 and January 2020â¯at our institution. Toxicities were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE version 5.0).RESULTS:
The 87 patients received treatment with a median boost of 63â¯Gy to the primary tumor. With a median follow-up of 32 months, the 3year CFS, OS, LRC, and PFS were 79.5%, 71.4%, 83.9%, and 78.5%, respectively. Tumor relapse occurred in 13 patients (14.9%). Dose escalation to >â¯63â¯Gy (maximum 66.6â¯Gy) to the primary tumor in 38/87 patients revealed a nonsignificant trend for improved 3year CFS (82.4% vs. 97%, Pâ¯= 0.092), a significantly improved CFS for T2/T3 tumors (72.6% vs. 100%, Pâ¯= 0.008), and a significantly improved 3year PFS for T1/T2 tumors (76.7% vs. 100%, Pâ¯= 0.035). While acute toxicities did not differ, dose escalation >â¯63â¯Gy led to a higher rate of chronic skin toxicities (43.8% vs. 69%, Pâ¯= 0.042). Treatment with intensity-modulated radiotherapy (IMRT) showed a significant improvement in 3year OS (75.4% vs. 53.8%, Pâ¯= 0.048). In multivariate analysis, significant improvements for T1/T2 tumors (CFS, OS, LRC, PFS), G1/2 tumors (PFS), and IMRT (OS) were shown. The nonsignificant trend for CFS improvement with dose escalation >â¯63â¯Gy was also apparent in multivariate analysis (Pâ¯= 0.067).CONCLUSION:
Dose escalation >â¯63â¯Gy (maximum 66.6â¯Gy) may improve CFS and PFS for certain subgroups, with a concomitant increase in chronic skin toxicities. Modern IMRT seems to be associated with an improvement in OS.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Neoplasias del Ano
/
Carcinoma de Células Escamosas
/
Radioterapia de Intensidad Modulada
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
Strahlenther Onkol
Asunto de la revista:
NEOPLASIAS
/
RADIOTERAPIA
Año:
2023
Tipo del documento:
Article
País de afiliación:
Alemania