title: Efficacy and toxicity of chemoradiation in patients with anal cancer--a retrospective analysis.
abstract: BACKGROUND
  Concurrent chemotherapy and radiation therapy is the preferred standard of care for patients with anal cancer. Several studies have suggested a benefit of intensity-modulated radiation therapy (IMRT) compared with 3D-conformal radiation (3D-CRT) regarding acute toxicity. This study evaluates outcome and toxicity of patients undergoing IMRT/Tomotherapy or 3D-CRT at our institution.
  
  
  METHODS
  A cohort of 105 anal cancer patients was treated with chemoradiation or radiation alone (16.2%) between January 2000 and December 2011. 37 patients received 3D-CRT while 68 patients were treated with IMRT. Follow-up exams were performed every 3 to 6 months for a minimum of 3 years and then annually.
  
  
  RESULTS
  Median follow-up was 41.4 months (2.8 - 158.4). Overall survival (OS), Progression-free survival (PFS) and local control (LC) at 3 years was 70.3%, 66.5%, 78.3% in the 3D-CRT group and 82.9%, 66.5%, 75.3% in the IMRT group without statistically significant difference. 3-year Colostomy-free survival (CFS) was 85.7% in the IMRT/Tomotherapy group and 91.8% in the 3D-CRT group (p = 0.48). No grade 4 toxicity was found in both groups. Severe (G2/3) acute skin toxicity (94.6% vs. 63.2%; p < 0.001) and acute gastrointestinal toxicity rate (67.6% vs. 47.1%; p = 0.03) was significantly higher with 3D-CRT compared to IMRT/Tomotherapy.
  
  
  CONCLUSIONS
  The use of IMRT can reduce acute severe side effects of the skin and gastrointestinal tract but did not demonstrate improved results regarding OS, PFS, LC and CFS.
authors.affiliation: Department of Radiation Oncology, University Hospital, Heidelberg, Germany. Stefan.Koerber@med.uni-heidelberg.de.
authors.forename: Stefan Alexander
authors.initials: SA
authors.lastname: Koerber
authors.forename: Alla
authors.initials: A
authors.lastname: Slynko
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Haefner
authors.forename: David
authors.initials: D
authors.lastname: Krug
authors.forename: Clara
authors.initials: C
authors.lastname: Schoneweg
authors.forename: Kerstin
authors.initials: K
authors.lastname: Kessel
authors.forename: Annette
authors.initials: A
authors.lastname: Kopp-Schneider
authors.forename: Klaus
authors.initials: K
authors.lastname: Herfarth
authors.forename: Juergen
authors.initials: J
authors.lastname: Debus
authors.forename: Florian
authors.initials: F
authors.lastname: Sterzing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001005:Anus Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult