Interstitial pulsed-dose-rate brachytherapy for the treatment of squamous cell anal carcinoma: A retrospective single institution analysis.
OBJECTIVE
To examine the outcome of patients receiving interstitial pulsed-dose-rate brachytherapy (PDR-BT) after pelvic radiation therapy for treatment of an anal squamous cell carcinoma.


METHODS
Twenty-one patients were identified: 13, six, and two with stages I, II, and III tumors, respectively. After receiving received pelvic irradiation +/- concurrent chemotherapy, patients were delivered a PDR-BT boost to the residual tumor, with intention to deliver a minimal total dose of 60 Gy. The greatest dimension of residual tumor at the time of brachytherapy procedure was 12.5 mm (range: 0-20 mm). Brachytherapy implantation was performed according to the Paris system, only one plane implant being used.


RESULTS
Median dose delivered through BT was 20 Gy (range: 10-30 Gy). Median number of pulses was 48 (range: 20-80 pulses). Median treated volume was 9 cm(3) (range: 5-16 cm(3)). Median dose per pulse was 40 cGy (range: 37.5-50 cGy). No Grade 3 or more acute toxicity was reported. No Grade 3 or more delayed toxicity was seen among 18 patients with more than 6 months follow-up. Median followup was 47 months (range: 6-73 months). Twenty patients (95%) were alive at last follow-up. Tumor relapses were experienced in four patients (19%), including local relapse in three patients (14%).


CONCLUSIONS
With almost 4 years median followup, this study confirms previous data suggesting that PDR-BT is effective and safe in this indication. Local control rate and toxicity were in the range of what was seen with continuous low-dose-rate BT.
Department of Radiotherapy-Brachytherapy Service, Gustave Roussy, Villejuif, France.
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W
Boukhelif
Department of Radiotherapy-Brachytherapy Service, Gustave Roussy, Villejuif, France.
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M
Ferri-Molina
Department of Radiotherapy-Brachytherapy Service, Gustave Roussy, Villejuif, France.
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R
Mazeron
Department of Radiotherapy-Brachytherapy Service, Gustave Roussy, Villejuif, France.
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P
Maroun
Department of Radiotherapy-Brachytherapy Service, Gustave Roussy, Villejuif, France.
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AS
Duhamel-Oberlander
Department of Radiotherapy-Brachytherapy Service, Gustave Roussy, Villejuif, France.
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I
Dumas
Department of Radiotherapy-Brachytherapy Service, Gustave Roussy, Villejuif, France.
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F
Martinetti
Department of Radiotherapy-Brachytherapy Service, Gustave Roussy, Villejuif, France.
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A
Guemnie-Tafo
Department of Radiotherapy-Brachytherapy Service, Gustave Roussy, Villejuif, France; Department of Radiotherapy-Hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France.
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C
Chargari
Department of Radiotherapy-Brachytherapy Service, Gustave Roussy, Villejuif, France. Electronic address: christine.haiemeder@gustaveroussy.fr.
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Haie-Meder
D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012189:Retrospective Studies
Anal squamous cell carcinoma; Brachytherapy; Pulsed-dose-rate