title: Volumetric intensity-modulated arc therapy vs. 3-dimensional conformal radiotherapy for primary chemoradiotherapy of anal carcinoma: Effects on treatment-related side effects and survival.
abstract: BACKGROUND
  Primary chemoradiotherapy (CRT) is the standard treatment for locally advanced anal carcinoma. This study compared volumetric intensity-modulated arc therapy (VMAT) to 3-dimensional conformal radiotherapy (3DCRT) in terms of treatment-related side effects and survival.
  
  
  METHODS
  From 1992-2014, 103 consecutive patients with anal carcinoma UICC stage I-III were treated. Concomitant CRT consisted of whole pelvic irradiation, including the iliac and inguinal lymph nodes, with 50.4 Gy (1.8 Gy per fractions) by VMAT (n = 17) or 3DCRT (n = 86) as well as two cycles of 5-fluorouracil and mitomycin C. Acute organ and hematological toxicity were assessed according to the Common Terminology Criteria (CTC) for Adverse Events version 3.0. Side effects ≥ grade 3 were scored as high-grade toxicity.
  
  
  RESULTS
  High-grade acute organ toxicity CTC ≥ 3 (P < 0.05), especially proctitis (P = 0.03), was significantly reduced in VMAT patients. The 2-year locoregional control (LRC) and disease-free survival (DFS) were both 100 % for VMAT patients compared with 80 and 73 % for 3DCRT patients.
  
  
  CONCLUSIONS
  VMAT was shown to be a feasible technique, achieving significantly lower rates of acute organ toxicity and promising results for LRC and DFS. Future investigations will aim at assessing the advantages of VMAT with respect to late toxicity and survival after a prolonged follow-up time.
authors.affiliation: Dept. of Radiotherapy and Radiooncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Hanne Elisabeth
authors.initials: HE
authors.lastname: Weber
authors.affiliation: Dept. of Radiotherapy and Radiooncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Leif Hendrik
authors.initials: LH
authors.lastname: Dröge
authors.affiliation: Dept. of Radiotherapy and Radiooncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Hennies
authors.affiliation: Dept. of Radiotherapy and Radiooncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Markus Karl
authors.initials: MK
authors.lastname: Herrmann
authors.affiliation: Dept. of General Surgery, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Gaedcke
authors.affiliation: Dept. of Radiotherapy and Radiooncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. hendrik.wolff@med.uni-goettingen.de.
authors.forename: Hendrik Andreas
authors.initials: HA
authors.lastname: Wolff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000401:mortality* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011832:Radiation Injuries / Q000209:etiology / Q000401:mortality*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: 5-Flurouracil; Anal carcinoma; Chemoradiotherapy; Mitomycin C; Toxicity