title: Anal canal cancer: management of inguinal nodes and benefit of prophylactic inguinal irradiation (CORS-03 Study).
abstract: OBJECTIVE
  To evaluate the benefit of prophylactic inguinal irradiation (PII) in anal canal squamous cell carcinoma (ASCC).
  
  
  METHODS
  This retrospective study analyzed the outcome of 208 patients presenting with ASCC treated between 2000 and 2004 in four cancer centers of the south of France.
  
  
  RESULTS
  The population study included 35 T1, 86 T2, 59 T3, 20 T4, and 8 T stage unknown patients. Twenty-seven patients presented with macroscopic inguinal node involvement. Of the 181 patients with uninvolved nodes at presentation, 75 received a PII to a total dose of 45-50 Gy (PII group) and 106 did not receive PII (no PII group). Compared with the no PII group, patients in the PII group were younger (60% vs. 41% of patients age <68 years, p = 0.01) and had larger tumor (T3-4 = 46% vs. 27% p = 0.01). The other characteristics were well balanced between the two groups. Median follow-up was 61 months. Fourteen patients in the no PII group vs. 1 patient in the PII group developed inguinal recurrence. The 5-year cumulative rate of inguinal recurrence (CRIR) was 2% and 16% in PII and no PII group respectively (p = 0.006). In the no PII group, the 5-year CRIR was 12% and 30% for T1-T2 and T3-T4 respectively (p = 0.02). Overall survival, disease-specific survival, and disease-free survival were similar between the two groups. In the PII group, no Grade >2 toxicity of the lower extremity was observed.
  
  
  CONCLUSIONS
  PII with a dose of 45 Gy is safe and highly efficient to prevent inguinal recurrence and should be recommended for all T3-4 tumors. For early-stage tumors, PII should also be discussed, because the 5-year inguinal recurrence risk remains substantial when omitting PII (about 10%).
authors.affiliation: Department of Radiation Therapy, Antoine Lacassagne Cancer Center, Nice, France. c.ortholan@wanadoo.fr
authors.forename: Cécile
authors.initials: C
authors.lastname: Ortholan
authors.forename: Michel
authors.initials: M
authors.lastname: Resbeut
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Hannoun-Levi
authors.forename: Eric
authors.initials: E
authors.lastname: Teissier
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Gerard
authors.forename: Philippe
authors.initials: P
authors.lastname: Ronchin
authors.forename: Audrey
authors.initials: A
authors.lastname: Zaccariotto
authors.forename: Mathieu
authors.initials: M
authors.lastname: Minsat
authors.forename: Karen
authors.initials: K
authors.lastname: Benezery
authors.forename: Eric
authors.initials: E
authors.lastname: François
authors.forename: Naji
authors.initials: N
authors.lastname: Salem
authors.forename: Steve
authors.initials: S
authors.lastname: Ellis
authors.forename: David
authors.initials: D
authors.lastname: Azria
authors.forename: Cédric
authors.initials: C
authors.lastname: Champetier
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gross
authors.forename: Didier
authors.initials: D
authors.lastname: Cowen
mesh_terms: D000367:Age Factors; D000368:Aged; D001005:Anus Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D007264:Inguinal Canal; D015182:Lymphatic Irradiation / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011829:Radiation Dosage; D012189:Retrospective Studies; D047368:Tumor Burden