title: Role of brachytherapy in the boost management of anal carcinoma with node involvement (CORS-03 study).
abstract: OBJECTIVE
  To assess retrospectively the clinical outcome in anal cancer patients, with lymph node involvement, treated with split-course radiation therapy and receiving a boost through external beam radiation therapy (EBRT) or brachytherapy (BCT).
  
  
  METHODS
  From 2000 to 2005, among 229 patients with invasive nonmetastatic anal squamous cell carcinoma, a selected group of 99 patients, with lymph node involvement, was studied. Tumor staging reported was T1 in 4 patients, T2 in 16 patients, T3 in 49 patients, T4 in 16 patients, and T unknown in 14 patients and as N1 in 67 patients and N2/N3 in 32 patients. Patients underwent a first course of EBRT (mean dose, 45.1 Gy) followed by a boost (mean dose, 18 Gy) using EBRT (50 patients) or BCT (49 patients). All characteristics of patients and tumors were well balanced between the BCT and EBRT groups. Prognostic factors of cumulative rate of local recurrence (CRLR), cumulative rate of distant (including nodal) recurrence (CRDR), colostomy-free survival (CFS) rate, and overall survival (OS) rate were analyzed for the overall population and according to the nodal status classification.
  
  
  RESULTS
  The median follow-up was 71.5 months. The 5-year CRLR, CRDR, CFS rate, and OS rate were 21%, 19%, 63%, and 74.4%, respectively. In the overall population, the type of node involvement (N1 vs N2/N3) was the unique independent prognostic factor for CRLR. In N1 patients, by use of multivariate analysis, BCT boost was the unique prognostic factor for CRLR (4% for BCT vs 31% for EBRT; hazard ratio, 0.08; P=.042). No studied factors were significantly associated with CRDR, CFS, and OS. No difference with regard to boost technique and any other factor studied was observed in N2/N3 patients for any kind of recurrence.
  
  
  CONCLUSIONS
  In anal cancer, even in the case of initial perirectal node invasion, BCT boost is superior to EBRT boost for CRLR, without an influence on OS, suggesting that N1 status should not be a contraindication to use of a BCT boost technique, as well as emphasizing the important of investigating the benefit of BCT boost in prospective randomized trials.
authors.affiliation: Department of Radiation Therapy, Institut Paoli Calmettes, Marseille, France. moureaul@ipc.unicancer.fr
authors.forename: Laurence
authors.initials: L
authors.lastname: Moureau-Zabotto
authors.forename: Cecile
authors.initials: C
authors.lastname: Ortholan
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Hannoun-Levi
authors.forename: Eric
authors.initials: E
authors.lastname: Teissier
authors.forename: Didier
authors.initials: D
authors.lastname: Cowen
authors.forename: Nagi
authors.initials: N
authors.lastname: Salem
authors.forename: Claire
authors.initials: C
authors.lastname: Lemanski
authors.forename: Steve
authors.initials: S
authors.lastname: Ellis
authors.forename: Michel
authors.initials: M
authors.lastname: Resbeut
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology; D001005:Anus Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden; D014625:Vaginal Neoplasms / Q000473:pathology