Radiation therapy of anal canal cancer: from conformal therapy to volumetric modulated arc therapy
Menée à partir de données portant sur 64 patients atteints d'un carcinome du canal anal, cette étude compare l'efficacité, du point de vue du contrôle loco-régional et de la survie spécifique à 5 ans, et la toxicité d'une arc-thérapie volumétrique avec modulation d'intensité et d'une radiothérapie conformationnelle
Background : To appraise the role of volumetric modulated arc (RapidArc, RA) in the treatment of anal canal carcinoma (ACC). Methods : A retrospective analysis has been conducted on 36 patients treated with RA since 2009 comparing outcome against a group of 28 patients treated with conformal therapy (CRT). RA treatments were prescribed with SIB technique with 59.4Gy to the primary tumor and nodes and 49.5Gy to the elective nodes. CRT was sequentially delivered with 45Gy to the pelvic target and a boost of 14.4Gy to the primary tumor. Results : Median age of patients was 65 yrs for RA (59 yrs for CRT); 90% had Stage II-III (93% in the CRT group). No statistically significant differences were observed concerning survival or control. 5 yrs disease specific survival was 85.7% and 81.2%, loco-regional control was of 78.1% and 82.1% for RA and CRT respectively. RA treatments lead to lower incidence of higher grade of toxicity events (all retrospectively retrieved from charts as worse events). Grade 2-3 toxicity, compared to CRT, reduced from 89% to 68% for GI, from 39% to 33% for GU and from 82% to 75% for the skin. Late toxicity was as follows: 5/36 (14%) and 3/36 (8%) patients had G1 or G2 GI toxicity in the RA group (1/28 (4%) and 4/28 (14%) in the CRT group). GU late toxicity was observed only in 4/28 (14%) patients of the CRT group: 3/28 (11%) had G2 and 1/28 (4%) had G1. Conclusions : RA treatments of ACC patients proved to be equally effective than CRT but it was associated to a reduction of toxicity.
BMC Cancer 2014