Radiation therapy of anal canal cancer: from conformal therapy to volumetric modulated arc therapy.
BACKGROUND
To appraise the role of volumetric modulated arc (RapidArc, RA) in the treatment of anal canal carcinoma (ACC).


METHODS
A retrospective analysis has been conducted on 36 patients treated with RA since 2009 comparing outcome against a group of 28 patients treated with conformal therapy (CRT). RA treatments were prescribed with SIB technique with 59.4 Gy to the primary tumor and nodes and 49.5 Gy to the elective nodes. CRT was sequentially delivered with 45 Gy to the pelvic target and a boost of 14.4 Gy to the primary tumor.


RESULTS
Median age of patients was 65 yrs for RA (59 yrs for CRT); 90% had Stage II-III (93% in the CRT group). No statistically significant differences were observed concerning survival or control. 5 yrs disease specific survival was 85.7% and 81.2%, loco-regional control was of 78.1% and 82.1% for RA and CRT respectively. RA treatments lead to lower incidence of higher grade of toxicity events (all retrospectively retrieved from charts as worse events). Grade 2-3 toxicity, compared to CRT, reduced from 89% to 68% for GI, from 39% to 33% for GU and from 82% to 75% for the skin. Late toxicity was as follows: 5/36 (14%) and 3/36 (8%) patients had G1 or G2 GI toxicity in the RA group (1/28 (4%) and 4/28 (14%) in the CRT group). GU late toxicity was observed only in 4/28 (14%) patients of the CRT group: 3/28 (11%) had G2 and 1/28 (4%) had G1.


CONCLUSIONS
RA treatments of ACC patients proved to be equally effective than CRT but it was associated to a reduction of toxicity.
Angelo
A
Tozzi
Department of Radiotherapy and Radiosurgery, Istituto Clinico Humanitas Cancer Center, Rozzano, Milan, Italy. luca.cozzi@humanitas.it.
Luca
L
Cozzi
Cristina
C
Iftode
Annamaria
A
Ascolese
Maria Concetta
MC
Campisi
Elena
E
Clerici
Tiziana
T
Comito
Fiorenza
F
De Rose
Antonella
A
Fogliata
Ciro
C
Franzese
Pietro
P
Mancosu
Piera
P
Navarria
Stefano
S
Tomatis
Elisa
E
Villa
Marta
M
Scorsetti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D041981:Gastrointestinal Tract / Q000528:radiation effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D012867:Skin / Q000528:radiation effects*; D015996:Survival Rate; D014566:Urogenital System / Q000528:radiation effects*