title: Does gap-free intensity modulated chemoradiation therapy provide a greater clinical benefit than 3D conformal chemoradiation in patients with anal cancer?
abstract: BACKGROUND
  Chemoradiation is the standard treatment for anal cancer. 3D conformal radiotherapy (3D-CRT) is usually split in 2 sequences with a therapeutic break (gap) in between. Intensity-modulated radiation therapy (IMRT) makes it possible to reduce treatment time by abandoning this gap. The purpose of this study was to compare outcomes and toxicities in patients treated with either IMRT or 3D-CRT.
  
  
  METHODS
  Between 2004 and 2011, the data of 51 patients treated with exclusive radiotherapy with or without concomitant chemotherapy for non-metastatic anal carcinoma were retrospectively analyzed. Twenty-seven patients were treated with 3D-CRT and 24 patients with IMRT, with a median dose delivered to the tumor of 59.4Gy [30.6-66.6], whatever the radiotherapy technique (p= 0.99). The median follow-up was 40 months [26.4-51.6].
  
  
  RESULTS
  There was no difference between the two groups for response to treatment (p= 0.46). Two-year overall survival, locoregional relapse-free survival and colostomy-free survival rates were 88.5%, 63% and 60.3%, respectively for the IMRT group and 81%, 76.5% and 81.1% for the 3D-CRT group (all NS). Ten patients (37%) in 3D-CRT and 11 patients (45.8%) in IMRT (p= 0.524) had grade 3 acute toxicity. No grade 4 toxicity occurred.
  
  
  CONCLUSIONS
  Our study suggests that further investigations concerning the use of IMRT to treat cancer of the anus are warranted. IMRT makes it possible to remove the gap, but with no impact on the prognosis. Nonetheless, a longer follow-up is essential to determine whether or not IMRT has an impact on late toxicity, local control and survival compared with conventional 3D-CRT.
authors.affiliation: Department of Radiation Oncology, Anticancer center Georges François Leclerc, 1 rue du Professeur Marion, Dijon 21000, France.
authors.forename: Claire Vautravers
authors.initials: CV
authors.lastname: Dewas
authors.forename: Philippe
authors.initials: P
authors.lastname: Maingon
authors.forename: Cécile
authors.initials: C
authors.lastname: Dalban
authors.forename: Aurélie
authors.initials: A
authors.lastname: Petitfils
authors.forename: Karine
authors.initials: K
authors.lastname: Peignaux
authors.forename: Gilles
authors.initials: G
authors.lastname: Truc
authors.forename: Etienne
authors.initials: E
authors.lastname: Martin
authors.forename: Cédric
authors.initials: C
authors.lastname: Khoury
authors.forename: Sylvain
authors.initials: S
authors.lastname: Dewas
authors.forename: Gilles
authors.initials: G
authors.lastname: Créhange
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000069287:Capecitabine; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D003841:Deoxycytidine; D016685:Mitomycin; D000069287:Capecitabine; D002945:Cisplatin; D005472:Fluorouracil