Initial Results from the Royal College of Radiologists' UK National Audit of Anal Cancer Radiotherapy 2015.
OBJECTIVE
UK guidance was recently developed for the treatment of anal cancer using intensity-modulated radiotherapy (IMRT). We audited the current use of radiotherapy in UK cancer centres for the treatment of anal cancer against such guidance. We describe the acute toxicity of IMRT in comparison with patient population in the audit treated with two-phase conformal radiotherapy and the previous published data from two-phase conformal radiotherapy, in the UK ACT2 trial.


METHODS
A Royal College of Radiologists' prospective national audit of patients treated with radiotherapy in UK cancer centres was carried out over a 6 month period between February and July 2015.


RESULTS
Two hundred and forty-two cases were received from 40/56 cancer centres (71%). In total, 231 (95%) underwent full dose radiotherapy with prophylactic nodal irradiation. Of these, 180 (78%) received IMRT or equivalent, 52 (22%) two-phase conformal (ACT2) technique. The number of interruptions in radiotherapy treatment in the ACT2 trial was 15%. Interruptions were noted in 7% (95% confidence interval 0-14%) of courses receiving two-phase conformal and 4% (95% confidence interval 1-7%) of those receiving IMRT. The percentage of patients completing the planned radiotherapy dose, irrelevant of gaps, was 90% (95% confidence interval 82-98%) and 96% (95% confidence interval 93-99%), in two-phase conformal and IMRT respectively. The toxicity reported in the ACT2 trial, in patients receiving two-phase conformal in the audit and in patients receiving IMRT in the audit was: any toxic effect 71%, 54%, 48%, non-haematological 62%, 49%, 40% and haematological 26%, 13%, 18%, respectively.


CONCLUSIONS
IMRT implementation for anal cancer is well underway in the UK with most patients receiving IMRT delivery, although its usage is not yet universal. This audit confirms that IMRT results in reduced acute toxicity and minimised treatment interruptions in comparison with previous two-phase conformal techniques.
CRUK MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK. Electronic address: rebeccamuirhead@oncology.ox.ac.uk.
R
R
Muirhead
The Royal College of Radiologists, London, UK.
K
K
Drinkwater
Oxford University Hospitals NHS Trust, Department of Oncology, Churchill Hospital, Oxford, UK.
S M
SM
O'Cathail
Cardiff University Department of Cancer and Genetics and Velindre Hospital, Cardiff, UK.
R
R
Adams
Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK.
R
R
Glynne-Jones
Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK.
M
M
Harrison
CRUK MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK.
M A
MA
Hawkins
University of Leeds, Cancer Research UK Leeds Centre, St. James's University Hospital, Leeds, UK.
D
D
Sebag-Montefiore
Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK.
D C
DC
Gilbert
D000328:Adult; D001005:Anus Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods
Acute toxicity; IMRT; anal cancer; audit