title: [Management of locally advanced anal canal carcinoma with modulated arctherapy and concurrent chemotherapy].
abstract: The standard treatment of locally advanced (stage II and III) squamous cell carcinoma of the anal canal consists of concurrent chemoradiotherapy (two cycles of 5-fluoro-uracil, mitomycin C, on a 28-day cycle), with a dose of 45 Gy in 1.8 Gy per fraction in the prophylactic planning target volume and additional 14 to 20 Gy in the boost planning target volume (5 days per week) with a possibility of 15 days gap period between the two sequences. While conformal irradiation may only yield suboptimal tumor coverage using complex photon/electron field junctions (especially on nodal areas), intensity modulated radiation therapy techniques (segmented static, dynamic, volumetric modulated arc therapy and helical tomotherapy) allow better tumour coverage while sparing organs at risk from intermediate/high doses (small intestine, perineum/genitalia, bladder, pelvic bone, etc.). Such dosimetric advantages result in fewer severe acute toxicities and better potential to avoid a prolonged treatment break that increases risk of local failure. These techniques also allow a reduction in late gastrointestinal and skin toxicities of grade 3 or above, as well as better functional conservation of anorectal sphincter. The technical achievements (simulation, contouring, prescription dose, treatment planning, control quality) of volumetric modulated arctherapy are discussed.
authors.affiliation: Oncologie-radiothérapie, CHRU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France. Electronic address: idriss.troussier@me.com.
authors.forename: I
authors.initials: I
authors.lastname: Troussier
authors.affiliation: Service d'oncologie-radiothérapie, hôpital Tenon, hôpitaux universitaires Est parisien, 4, rue de la Chine, 75020 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Huguet
authors.affiliation: Oncologie-radiothérapie, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France.
authors.forename: S
authors.initials: S
authors.lastname: Servagi-Vernat
authors.affiliation: Oncologie-radiothérapie, centre Jean-Perrin, CLCC d'Auvergne, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Benahim
authors.affiliation: Oncologie-radiothérapie, institut Claudius-Régaud, institut universitaire du cancer de Toulouse-Oncopôle, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France.
authors.forename: J
authors.initials: J
authors.lastname: Khalifa
authors.affiliation: Oncologie-radiothérapie, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex, France.
authors.forename: I
authors.initials: I
authors.lastname: Darmon
authors.affiliation: Oncologie-radiothérapie, centre hospitalier Princesse-Grace, avenue Pasteur, 98000 Monaco, Monaco.
authors.forename: C
authors.initials: C
authors.lastname: Ortholan
authors.affiliation: Oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Krebs
authors.affiliation: Oncologie-radiothérapie, institut universitaire de la face et du cou, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France.
authors.forename: C
authors.initials: C
authors.lastname: Dejean
authors.affiliation: Service d'oncologie-radiothérapie, ICM-Val d'Aurelle, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France.
authors.forename: P
authors.initials: P
authors.lastname: Fenoglietto
authors.affiliation: Oncologie-radiothérapie, centre catalan d'oncologie, 80, rue Pascal-Marie-Agasse, 66000 Perpignan, France.
authors.forename: S
authors.initials: S
authors.lastname: Vieillot
authors.affiliation: Oncologie-radiothérapie, centre de haute énergie, 10, boulevard Pasteur, 06000 Nice, France.
authors.forename: R-J
authors.initials: RJ
authors.lastname: Bensadoun
authors.affiliation: Oncologie-radiothérapie, institut universitaire de la face et du cou, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France.
authors.forename: J
authors.initials: J
authors.lastname: Thariat
mesh_terms: D001003:Anal Canal / Q000503:physiopathology / Q000528:radiation effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy; D059248:Chemoradiotherapy; D017326:Clinical Trials, Phase III as Topic; D003198:Computer Simulation; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D015182:Lymphatic Irradiation; D016685:Mitomycin / Q000008:administration & dosage; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D058958:Organs at Risk; D019047:Phantoms, Imaging; D011300:Preoperative Care; D011786:Quality Control; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011855:Radiodermatitis / Q000209:etiology / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated
chemical_list: D016685:Mitomycin; D005472:Fluorouracil
keywords: Anal canal; Arcthérapie volumique modulée; Canal anal; Cancer; Carcinome épidermoïde; Chemoradiotherapy; Chimioradiothérapie; Dynamic intensity modulated radiation therapy; Gap; Helical tomotherapy; Intervalle libre; Local control; RCMI dynamique; Squamous cell carcinoma; Static segmented IMRT; Statique segmentée; Tomothérapie hélicoïdale; Treatment break; Volumetric modulated arc therapy