Objective: Concurrent chemoradiotherapy (CCRT) is the standard curative treatment option for nonmetastatic anal squamous cell carcinoma (SCC). Intensity modulated radiotherapy (IMRT) can reduce doses delivered to bowel and skin and reduce toxicities associated with conventional fields. Here, we present our institutional data on dosimetry, toxicity, and clinical outcomes with IMRT for anal cancer.
Materials and Methods: We analyzed 23 patients of anal SCC treated with curative-intent CCRT/radiation therapy alone, utilizing IMRT, between August 2011 and December 2016. The standard prescription dose was 54 Gy/27Fr/5.5 weeks, delivered in two phases, and concurrent chemotherapy with 5-fluorouracil and mitomycin-C. Acute and late toxicities and dosimetric data were compiled and analyzed.
Results: The median age was 65 years. Fourteen (60.7%) patients had Stage IIIC disease. Eighteen patients received concurrent chemotherapy. No patient had any treatment breaks. Grade 3 acute perianal dermatitis was recorded in 11 (47.8%) patients. Proctitis, diarrhea, and cystitis were limited to Grade 1 in 73.9%, 47.8%, and 8.6% patients, respectively. The only late Grade 2+ toxicities were gastrointestinal toxicities in 4 (17.4%) patients. Twenty (87%) patients had complete response at 6 months. The 3-year local control, nodal control, and distant metastases-free survival were 85.9%, 86.6%, 84.7%, respectively, with 3-year disease-free survival and overall survival of 63.4% and 81%, respectively.
Conclusion: In this report on IMRT in anal cancer from India, treatment was well tolerated with lower acute toxicity than reported in other prospective studies. Long-term results are at par with other published studies.


中文翻译：

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肛管鳞状细胞癌的调强放疗：实施和结果


目的：同步放化疗（CCRT）是非转移性肛门鳞状细胞癌（SCC）的标准治疗选择。调强放射治疗 (IMRT) 可以减少输送到肠道和皮肤的剂量，并减少与常规领域相关的毒性。在这里，我们展示了我们关于 IMRT 治疗肛门癌的剂量测定、毒性和临床结果的机构数据。
材料和方法：我们分析了 23 名肛门 SCC 患者，他们在 2011 年 8 月至 2016 年 12 月期间使用 IMRT 单独接受根治性 CCRT/放射治疗。标准处方剂量为 54 Gy/27Fr/5.5 周，分两个阶段交付，与 5-氟尿嘧啶和丝裂霉素-C 同步化疗。收集和分析急性和晚期毒性和剂量学数据。
结果：中位年龄为 65 岁。14 名 (60.7%) 患者患有 IIIC 期疾病。18 名患者接受了同步化疗。没有患者有任何治疗中断。11 名（47.8%）患者出现 3 级急性肛周皮炎。直肠炎、腹泻和膀胱炎分别有 73.9%、47.8% 和 8.6% 的患者被限制在 1 级。4 名 (17.4%) 患者的唯一晚期 2+ 级毒性是胃肠道毒性。20 名 (87%) 患者在 6 个月时完全缓解。3年局部控制、淋巴结控制和无远处转移生存率分别为85.9%、86.6%、84.7%，3年无病生存率和总生存率分别为63.4%和81%。
结论：在这份来自印度的关于 IMRT 治疗肛门癌的报告中，治疗耐受性良好，急性毒性低于其他前瞻性研究报告。长期结果与其他已发表的研究相当。