title: Early-stage Node-negative (T1-T2N0) Anal Cancer Treated with Simultaneous Integrated Boost Radiotherapy and Concurrent Chemotherapy.
abstract: OBJECTIVE
  To report clinical outcomes of a consecutive series of patients with early-stage (T1-T1N0) anal cancer treated with intensity-modulated radiotherapy (IMRT) and a simultaneous integrated boost (SIB) approach similarly to the RTOG 05-29 trial.
  
  
  METHODS
  A cohort of 43 patients underwent SIB-IMRT employing a schedule consisting of 50.4 Gy/28 fractions to the gross tumor volume and 42 Gy/28 fractions to the elective nodal volumes for cT1N0 cases, and 54 Gy/30 fractions and 45 Gy/30 fractions to the same volumes for cT2N0 cases. Chemotherapy was administered concurrently following Nigro's regimen. The primary endpoint was colostomy-free survival (CFS). Secondary endpoints were locoregional control (LRC), disease-free (DFS), cancer-specific (CSS) and overall (OS) survival.
  
  
  RESULTS
  Median follow-up was 39.7 months. The actuarial 3-year CFS was 79.4% [95% confidence interval (CI)=61.4-89.7%]. Actuarial 3-year OS and CSS were 90.8% (95% CI=74.1-96.9%) and 93.8% (95% CI=77.3-98.4%), while DFS was 75.5% (95% CI=56.4-87.1%). Actuarial 3-year LRC was 86.1% (95% CI=69.6-94%). On multivariate analysis, tumor size >3 cm showed a trend towards significance in predicting CFS [hazard ratio (HR)=8.6, 95% CI=84.7-88.1%; p=0.069]. Maximum detected adverse events included: skin (G3): 18%; gastrointestinal tract (G2): 67%; genitourinary tract (G3): 3%; genitalia (G2): 30%; anemia (G2): 7%; leukopenia (G3): 26%, leukopenia (G4):7%; neutropenia (G3): 15%; neutropenia (G4): 12%; thrombocytopenia (G3): 9%.
  
  
  CONCLUSIONS
  Our clinical results support the use of SIB-IMRT in the combined modality treatment of patients with anal cancer.
authors.affiliation: Department of Oncology-Radiation Oncology, University of Turin, Turin, Italy pierfrancesco.franco@unito.it.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Franco
authors.affiliation: Department of Oncology-Radiation Oncology, University of Turin, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Arcadipane
authors.affiliation: Department of Oncology-Radiation Oncology, University of Turin, Turin, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ragona
authors.affiliation: Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mistrangelo
authors.affiliation: Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Cassoni
authors.affiliation: Department of Medical Imaging and Radiotherapy-Radiation Oncology, City of Health and Science Hospital, Turin, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Rondi
authors.affiliation: Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
authors.affiliation: Oncological Centre for Gastrointestinal Neoplasm, Medical Oncology 1, City of Health and Science Hospital, Turin, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Racca
authors.affiliation: Department of Oncology-Radiation Oncology, University of Turin, Turin, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects / Q000528:radiation effects
keywords: Anal cancer; IMRT; VMAT; acute toxicity; concomitant radiochemotherapy; radiotherapy; volumetric-modulated arc therapy