title: IMRT for locally advanced anal cancer: clinical experience of the Montpellier Cancer Center.
abstract: OBJECTIVE
  To assess outcomes of patients with carcinoma of the anal canal (CAC) treated with intensity-modulated radiation therapy (IMRT).
  
  
  METHODS
  From August 2007 to January 2011, seventy-two patients suffering from CAC were treated with IMRT. Concurrent chemotherapy was added in case of locally advanced tumors. Radiation course consisted in delivering an initial plan to the PTV1 defined as the primary tumor and the risk area including pelvic and inguinal nodes. Forty-five Gy in daily 1.8 Gy-daily fractions were delivered five days a week. A second plan of 14.4-20 Gy to the primary tumor (PTV2) was administered in 1.8-2 Gy-daily fractions, 5 days a week. We present here the results of dosimetry, toxicities, and clinical outcome of the first 39 patients with a median follow-up of 24 months.
  
  
  RESULTS
  Thirty-one women and eight men were included in the present analysis. Tumors were classified as stages I, II, III and IV in 2, 7, 27 and 2 patients, respectively. Median age was 59 years (range, 38-85). Radiotherapy alone (RT) or combined with chemotherapy (RCT) were delivered in 6 (15%) and 33 (85%) patients, respectively.Six patients (15%) required a treatment break ≥ 3 days, and median time for treatment break was 8 days (range, 3-14 days). Acute grade 3 gastrointestinal (GI) and genitourinary (GU) toxicities were seen in 10 and 5% of patients, respectively. Grade 4 toxicity was only hematologic and occurred in 12% patients receiving RCT. With a median follow-up of 24 months, no patient experienced any late grade 4 toxicity. The 2-year overall survival rate was 89%, the 2-year local relapse free survival was 77% and the 2-year colostomy-free survival rate was 85%.
  
  
  CONCLUSIONS
  IMRT is well tolerated with acceptable treatment interruption allowing dose escalation.
authors.affiliation: Département de Cancérologie Radiothérapie, CRLC Val d'Aurelle-Paul Lamarque, Montpellier, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Vieillot
authors.forename: Pascal
authors.initials: P
authors.lastname: Fenoglietto
authors.forename: Claire
authors.initials: C
authors.lastname: Lemanski
authors.forename: Carmen Llacer
authors.initials: CL
authors.lastname: Moscardo
authors.forename: Sophie
authors.initials: S
authors.lastname: Gourgou
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Dubois
authors.forename: Norbert
authors.initials: N
authors.lastname: Aillères
authors.forename: David
authors.initials: D
authors.lastname: Azria
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001005:Anus Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011829:Radiation Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods
chemical_list: D000970:Antineoplastic Agents