title: Concurrent chemotherapy and intensity-modulated radiation therapy for anal carcinoma--clinical outcomes in a large National Cancer Institute-designated integrated cancer centre network.
abstract: OBJECTIVE
  To report the clinical outcomes of patients with anal carcinoma treated with intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy in a large integrated academic-community cancer centre network.
  
  
  METHODS
  Seventy-eight patients were treated with IMRT for anal carcinoma at 13 community cancer centres. IMRT planning for all centres was carried out at one central location. Sixty-five patients (83%) were T1-T2, 64% were N0, 9% were M1; five patients were HIV positive. All but one patient received concurrent chemotherapy. The median dose to the pelvis including inguinal nodes was 45 Gy. The primary site and involved nodes were boosted to a median dose of 55.8 Gy. All acute and late toxicities were scored according to the Common Terminology Criteria for Adverse Events, version 3.0.
  
  
  RESULTS
  The median follow-up for the entire cohort was 16 months (range 0-72 months). Acute grade ≥3 toxicity included 27.7% gastrointestinal and 29.0% dermatological. Acute grade 4 haematological toxicity occurred in 12.9% of patients. Sixty-four (88.9%) patients experienced a complete response. The 2 year colostomy-free survival, overall survival, freedom from local failure and freedom from distant failure rates were 81.2, 86.9, 83.6 and 81.8%, respectively.
  
  
  CONCLUSIONS
  Early results seem to confirm that IMRT used concurrently with chemotherapy for treatment of anal carcinoma is effective and well tolerated. This complex treatment can be safely and effectively carried out in a large integrated healthcare network.
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: DeFoe
authors.forename: S
authors.initials: S
authors.lastname: Beriwal
authors.forename: H
authors.initials: H
authors.lastname: Jones
authors.forename: S
authors.initials: S
authors.lastname: Rakfal
authors.forename: D E
authors.initials: DE
authors.lastname: Heron
authors.forename: P
authors.initials: P
authors.lastname: Kabolizadeh
authors.forename: R P
authors.initials: RP
authors.lastname: Smith
authors.forename: R
authors.initials: R
authors.lastname: Lalonde
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D003151:Community Health Centers; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D054547:National Cancer Institute (U.S.); D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
chemical_list: D016685:Mitomycin; D002945:Cisplatin; D005472:Fluorouracil