title: Prospective phase II study of tomotherapy based chemoradiation treatment for locally advanced anal cancer.
abstract: OBJECTIVE
  To evaluate toxicity, local control, and survival of anal cancer patients treated with helical tomotherapy (HT) and concurrent 5-fluorouracil and mitomycin-C (5FU/MMC).
  
  
  METHODS
  Fifty-seven patients were treated with HT and concurrent 5FU/MMC. The planning objectives were to deliver 54 Gy to the tumor (PTV54) and 45 Gy to the nodes at risk (PTV45) in 30 fractions. Patients were reviewed for toxicity weekly during HT, every 6 weeks for 3 months, and then every 3-4 months for 5 years.
  
  
  RESULTS
  The median follow-up was 40 months. The median age was 58 years (range: 37-83). Stage distribution: stage II-48%, IIIA-18%, IIIB-34%. The majority of patients developed ⩽ grade 2 acute toxicity scores. The most common ⩾ grade 3 acute toxicity was neutropenia (40%). Common late toxicities were grade 2 anal incontinence (16%) and telangiectasia (12%). The 3 year colostomy-free survival rate was 77% (95% CI: 61-87%), 3 year disease-free survival rate was 80% (CI: 66-89%), and 3 year overall survival was 91% (CI: 77-96%).
  
  
  CONCLUSIONS
  Incorporation of HT with concurrent 5FU/MMC had low treatment-related acute and late morbidity with few treatment breaks. However, the expected dosimetric benefit for hematological toxicity was not experienced clinically.
authors: Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada. Electronic address: kurian.joseph@albertahealthservices.ca.
authors: Kurian
authors: K
authors: Joseph
authors: Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada.
authors: Yugmel
authors: Y
authors: Nijjar
authors: Division of Medical Physics, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada.
authors: Heather
authors: H
authors: Warkentin
authors: Department of Surgical Oncology, University of Alberta & Alberta Health Services, Edmonton, Canada.
authors: Dan
authors: D
authors: Schiller
authors: Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada.
authors: Keith
authors: K
authors: Tankel
authors: Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada.
authors: Nawaid
authors: N
authors: Usmani
authors: Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada.
authors: Diane
authors: D
authors: Severin
authors: Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada.
authors: Sunita
authors: S
authors: Ghosh
authors: Division of Medical Physics, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada.
authors: Alasdair
authors: A
authors: Syme
authors: Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada.
authors: Tirath
authors: T
authors: Nijjar
authors: Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada.
authors: Karen
authors: K
authors: Mulder
authors: Division of Radiation Oncology, Department of Oncology, University of Calgary & Tom Baker Cancer Centre, Canada.
authors: Corinne
authors: C
authors: Doll
authors: Department of Internal Gastroenterology, Royal Alexandra Hospital, Edmonton, Canada.
authors: Clarence
authors: C
authors: Wong
authors: Division of Medical Physics, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada.
authors: Colin
authors: C
authors: Field
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods
chemical_list: D016685:Mitomycin; D005472:Fluorouracil
keywords: Acute toxicity; Anal cancer; Helical tomotherapy; Intensity-modulated radiation therapy (IMRT); Late toxicity