PMID- 33732911 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220421 IS - 2405-6308 (Electronic) IS - 2405-6308 (Linking) VI - 28 DP - 2021 May TI - Intensity modulated radiotherapy for anal canal squamous cell carcinoma: A 16-year single institution experience. PG - 17-23 LID - 10.1016/j.ctro.2021.02.002 [doi] AB - INTRODUCTION: To report long-term efficacy and adverse events (AEs) associated with intensity modulated radiotherapy (IMRT) for patients with anal canal squamous cell carcinoma (ASCC). MATERIALS AND METHODS: This was a retrospective review of patients with ASCC who received curative-intent IMRT and concurrent chemotherapy (98%) between 2003 and 2019. Overall survival (OS), colostomy-free survival (CFS), and progression-free survival (PFS) were estimated using the Kaplan-Meier method. The cumulative incidence of local recurrence (LR), locoregional recurrence (LRR), and distant metastasis (DM) were reported. Acute and late AEs were recorded per National Cancer Institute Common Terminology Criteria for AEs. RESULTS: 127 patients were included. The median patient age was 63 years (interquartile range [IQR] 55-69) and 79% of patients were female. 33% of patients had T3-4 disease and 68% had clinically involved pelvic or inguinal lymph nodes (LNs).The median patient follow-up was 47 months (IQR: 28-89 months). The estimated 4-year OS, CFS, and PFS were 81% (95% confidence interval [CI]: 73%-89%), 77% (95% CI: 68%-86%), and 78% (95% CI: 70%-86%), respectively. The 4-year cumulative incidences of LR, LRR, and DM were 3% (95% CI: 1%-9%), 9% (95% CI: 5%-17%), and 10% (95% CI: 6%-18%), respectively. Overall treatment duration greater than 39 days was associated with an increased risk of LRR (Hazard Ratio [HR]: 5.2, 95% CI: 1.4-19.5, p = 0.015). The most common grade 3+ acute AEs included hematologic (31%), gastrointestinal (GI) (17%), dermatologic (16%), and pain (15%). Grade 3+ late AEs included: GI (3%), genitourinary (GU) (2%), and pain (1%). Current smokers were more likely to experience grade 3+ acute dermatologic toxicity compared to former or never smokers (34% vs. 7%, p < 0.001). CONCLUSIONS: IMRT was associated with favorable toxicity rates and long-term efficacy. These data support the continued utilization of IMRT as the preferred treatment technique for patients with ASCC. CI - (c) 2021 The Author(s). FAU - Jethwa, Krishan R AU - Jethwa KR AD - Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States. AD - Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, United States. FAU - Day, Courtney N AU - Day CN AD - Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States. FAU - Sandhyavenu, Harigopal AU - Sandhyavenu H AD - Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States. FAU - Gonuguntla, Karthik AU - Gonuguntla K AD - Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States. FAU - Harmsen, William S AU - Harmsen WS AD - Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States. FAU - Breen, William G AU - Breen WG AD - Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States. FAU - Routman, David M AU - Routman DM AD - Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States. FAU - Garda, Allison E AU - Garda AE AD - Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States. FAU - Hubbard, Joleen M AU - Hubbard JM AD - Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States. FAU - Halfdanarson, Thorvardur R AU - Halfdanarson TR AD - Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States. FAU - Neben-Wittich, Michelle A AU - Neben-Wittich MA AD - Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States. FAU - Merrell, Kenneth W AU - Merrell KW AD - Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States. FAU - Hallemeier, Christopher L AU - Hallemeier CL AD - Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States. FAU - Haddock, Michael G AU - Haddock MG AD - Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States. LA - eng GR - UL1 TR001863/TR/NCATS NIH HHS/United States PT - Journal Article DEP - 20210223 PL - Ireland TA - Clin Transl Radiat Oncol JT - Clinical and translational radiation oncology JID - 101713416 PMC - PMC7943964 OTO - NOTNLM OT - 3DCRT, 3-dimensional conformal radiotherapy OT - 5-FU, 5-fluorouracil OT - ACT II, United Kingdom Anal Cancer Trial II OT - AE, adverse events OT - ASCC, anal canal squamous cell carcinoma OT - Anal cancer OT - BED, biologically effective dose OT - CFS, colostomy-free survival OT - CI, confidence interval OT - CRT, chemoradiotherapy OT - CTCAE v 4.0, common terminology criteria for adverse events version 4.0 OT - CTV, clinical target volume OT - DM, distant metastasis OT - DP-IMRT, dose-painted intensity modulated radiotherapy OT - DVH, dose-volume histogram OT - G, grade OT - GI, gastrointestinal OT - GU, genitourinary OT - HIV, human immunodeficiency virus OT - HR, hazard ratio OT - IMRT OT - IMRT, intensity modulated radiotherapy OT - IQR, interquartile range OT - LN, lymph node OT - LR, local recurrence OT - LRR, locoregional recurrence OT - MMC, mitomycin-C OT - OS, overall survival OT - PFS, progression-free survival OT - PTV, planning target volume OT - RT, radiotherapy OT - RTOG, Radiation Therapy Oncology Group OT - Radiation COIS- The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Jethwa report honoraria from RadOncQuestions.com, LLC. EDAT- 2021/03/19 06:00 MHDA- 2021/03/19 06:01 PMCR- 2021/02/23 CRDT- 2021/03/18 06:54 PHST- 2020/11/15 00:00 [received] PHST- 2021/02/01 00:00 [revised] PHST- 2021/02/05 00:00 [accepted] PHST- 2021/03/18 06:54 [entrez] PHST- 2021/03/19 06:00 [pubmed] PHST- 2021/03/19 06:01 [medline] PHST- 2021/02/23 00:00 [pmc-release] AID - S2405-6308(21)00016-1 [pii] AID - 10.1016/j.ctro.2021.02.002 [doi] PST - epublish SO - Clin Transl Radiat Oncol. 2021 Feb 23;28:17-23. doi: 10.1016/j.ctro.2021.02.002. eCollection 2021 May.