French multicentre clinical evaluation of helical TomoTherapy for anal cancer in a cohort of 64 consecutive patients.
OBJECTIVE
To assess feasibility and toxicity of Helical TomoTherapy for treating anal cancer patients.


METHODS
From 2007 to 2011, 64 patients were consecutively treated with TomoTherapy in three centres for locally advanced squamous-cell anal carcinoma (T2 > 4 cm or N positive). Prescribed doses were 45 Gy to the pelvis including inguinal nodes and 59.4 Gy to the primary site and involved nodes with fractions of 1.8 Gy, five days a week. A positional Megavoltage Computed Tomography was performed before each treatment session. All acute and late toxicities were graded according to Common Terminology Criteria for Adverse Events version 3.0. Survival analysis was performed using the Kaplan-Meier method.


RESULTS
Median follow-up was 22.9 months. Fifty-four women and 10 men were treated (median age: 62 years). Nineteen patients (29.7%) had T2, 16 patients (25.0%) T3, and 27 patients (42.2%) T4 tumours. Thirty-nine patients (60.9%) had nodal involvement. Median tumour size was 45 mm (range, 10-110 mm). Seven patients had a colostomy before treatment initiation. Fifty-seven patients received concomitant chemotherapy (5-FU/cisplatin or 5-FU/mitomycin-based therapy). Forty-seven patients (73.4 %) experienced a complete response, 13 a partial response or local recurrence, and 11 had salvage surgery; among these, six became complete responders, three experienced metastatic failure, and two local failure. At least four patients experienced metastatic recurrence (concomitant to a local failure for one patient). The two-year overall survival was 85.6% (95 %CI [71.1%-93.0%]), and the one-year disease-free survival, and colostomy-free survival were 68.7% (95 %CI [54.4%-79.4]), and 75.5% (95 %CI [60.7%-85.3%]) respectively. Overall survival, disease-free survival and colostomy free-survival were significantly better for women than men (p = 0.002, p = 0.004, and p = 0.002 respectively). Acute grade ≥3 toxicity included dermatologic (46.9% of patients), gastrointestinal (20.3%), and hematologic (17.2%) toxicity. Acute grade 4 hematologic toxicity occurred in one patient. No grade 5 event was observed.


CONCLUSIONS
TomoTherapy for locally advanced anal cancer is feasible. In our three centres of expertise, this technique appeared to produce few acute gastrointestinal toxicities. However, high rates of dermatologic toxicity were observed. The therapeutic efficacy was within the range of expectations and similar to previous studies in accordance with the high rates of locally advanced tumours and nodal involvement.
Department of Radiation Oncology, Hospital Haut-Lévêque, CHU Bordeaux, Pessac, France. veronique.vendrely@chu-bordeaux.fr.|Service de Radiothérapie, Hôpital Haut Lévêque, avenue de Magellan, 33604, Pessac Cedex, France. veronique.vendrely@chu-bordeaux.fr.
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Vendrely
Department of Radiation Oncology, Institut Bergonié, Bordeaux, France. b.henriques@bordeaux.unicancer.fr.
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Henriques de Figueiredo
Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, France. Emmanuel.Rio@ico.unicancer.fr.
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Rio
Department of Radiation Oncology, Hospital Haut-Lévêque, CHU Bordeaux, Pessac, France. julie.benech@chu-bordeaux.fr.
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Benech
Department of Radiation Oncology, Institut Bergonié, Bordeaux, France. S.Belhomme@bordeaux.unicancer.fr.
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Belhomme
Department of Medical Physics, Institut de Cancérologie de l'Ouest, Nantes, France. Albert.Lisbona@ico.unicancer.fr.
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Lisbona
CHU de Bordeaux, Pole de santé publique, Service d'information médicale, F-33000, Bordeaux, France. eric.frison@isped.u-bordeaux2.fr.
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Frison
CHU de Bordeaux, Pole de santé publique, Service d'information médicale, F-33000, Bordeaux, France. Adelaide.Doussau@isped.u-bordeaux2.fr.
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Doussau
Department of Radiation Oncology, Hospital La Timone, Marseille, France. Natacha.NOMIKOSSOFF@ap-hm.fr.
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Nomikossoff
Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, France. Marc-Andre.Mahe@ico.unicancer.fr.
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Mahé
Department of Radiation Oncology, Institut Bergonié, Bordeaux, France. G.Kantor@bordeaux.unicancer.fr.
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Kantor
Department of Radiation Oncology, Hospital Haut-Lévêque, CHU Bordeaux, Pessac, France. renaud.trouette@chu-bordeaux.fr.
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Maire
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001005:Anus Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*
D002945:Cisplatin; D005472:Fluorouracil