title: Volumetric modulated arc therapy (VMAT) in the combined modality treatment of anal cancer patients.
abstract: OBJECTIVE
  To report clinical and dosimetric outcomes of a consecutive series of patients with anal cancer treated with volumetric-modulated arc therapy (VMAT) concomitant to chemotherapy (CT).
  
  
  METHODS
  A cohort of 39 patients underwent VMAT employing a schedule consisting of 50.4 Gy/28 fractions to the gross tumour volume (GTV) and 42 Gy/28 fractions to the elective nodal volumes for patients with cT2N0 disease. Patients with cT3-T4/N0-N3 tumours were prescribed 54 Gy/30 fractions to the GTV and 50.4 Gy/30 fractions to the gross nodal volumes if sized ≤3 cm or 54 Gy/30 fractions if > 3 cm. Elective nodal regions were given 45 Gy/30 fractions. CT was administered concurrently following Nigro's regimen. The primary end point was acute toxicity. Secondary end points were colostomy-free survival (CFS), disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS). Dosimetric data are also provided.
  
  
  RESULTS
  Median follow-up was 21 months. Maximum acute toxicities were: dermatologic-G3: 18%; gastrointestinal-G3: 5%; genitourinary-G3: 2%; anaemia-G2: 7%; leukopenia-G3: 28%; G4: 8%; neutropenia-G3: 13%; G4: 18%; thrombocytopenia-G3: 11%; and G4: 2%. The actuarial 2-year CFS was 77.9% [95% confidence interval (CI): 54-90.4%]. Actuarial 2-year OS and CSS were 85.2% (95% CI: 60.1-95.1%), while DFS was 75.1% (95% CI: 52.4.7-88.1%).
  
  
  CONCLUSIONS
  Our clinical results support the use of VMAT as a safe and effective intensity-modulated radiotherapy (IMRT) option in the combined modality treatment of anal cancer, with consistent dosimetry, mild toxicity and promising sphincter preservation and survival rates.
  
  
  CONCLUSIONS
  IMRT is a standard of care for patients with anal cancer, and VMAT is a robust technical solution in this setting.
authors.affiliation: 1 Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Franco
authors.affiliation: 1 Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Arcadipane
authors.affiliation: 1 Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ragona
authors.affiliation: 2 Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mistrangelo
authors.affiliation: 3 Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Cassoni
authors.affiliation: 4 Department of Medical Imaging and Radiotherapy, Radiation Oncology, AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Fernando
authors.initials: F
authors.lastname: Munoz
authors.affiliation: 4 Department of Medical Imaging and Radiotherapy, Radiation Oncology, AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Rondi
authors.affiliation: 2 Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
authors.affiliation: 5 Oncological Centre for Gastrointestinal Neoplasm, Medical Oncology 1, AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Racca
authors.affiliation: 1 Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000401:mortality / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods* / Q000401:mortality
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