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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 4/2020

01-04-2020 | Anal Cancer | Original Article

Improved treatment outcome and lower skin toxicity with intensity-modulated radiotherapy vs. 3D conventional radiotherapy in anal cancer

Authors: Dr. med. Matthias Sauter, Norbert Lombriser, Simon Bütikofer, Georg Keilholz, Helmut Kranzbühler, Henriette Heinrich, Gerhard Rogler, Stephan R. Vavricka, Benjamin Misselwitz

Published in: Strahlentherapie und Onkologie | Issue 4/2020

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Abstract

Purpose

Radiochemotherapy is the standard treatment for anal carcinoma (ACa). Intensity-modulated radiotherapy (IMRT) has been introduced, allowing focused irradiation of the tumor area. Whether physical benefits of IMRT translate to clinical benefits has not been sufficiently demonstrated.

Methods

We retrospectively reviewed data from 82 patients with newly diagnosed ACa. Patients treated with IMRT were compared with previous patients treated with conventional three-dimensional computational radiotherapy (3D-CRT). The influence of IMRT on complete remission and acute and chronic side effects was analyzed in univariate and multivariate analyses.

Results

39/40 patients treated with IMRT were in complete remission after 1 year compared to 31/39 patients treated with 3D-CRT (p = 0.014). Multivariate analysis confirmed tumor T stage as well as lack of IMRT treatment as risk factors for persistent tumor at 6 months. No significant benefits of IMRT were apparent at later timepoints (median follow up 52 months, IQR: 31.5–71.8 months). Patients treated with IMRT had a significantly lower degree of skin toxicity (median 2 vs. 3 in a scale ranging from 0 to 3, p = 0.00092). Rates of hematological toxicity/proctitis were not reduced and rates of acute diarrhea increased (p = 0.034). Median length of hospitalization tended to be shorter in patients treated with IMRT (n. s.).

Conclusion

We present a real-world experience of shifting radiation technique from conventional 3D-CRT to IMRT. IMRT patients had better tumor control at 1 year and lower degrees of skin toxicity. Our data indicate that IMRT can enable therapies with lower side effects with equal or better oncological results for patients with ACa.
Appendix
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Metadata
Title
Improved treatment outcome and lower skin toxicity with intensity-modulated radiotherapy vs. 3D conventional radiotherapy in anal cancer
Authors
Dr. med. Matthias Sauter
Norbert Lombriser
Simon Bütikofer
Georg Keilholz
Helmut Kranzbühler
Henriette Heinrich
Gerhard Rogler
Stephan R. Vavricka
Benjamin Misselwitz
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 4/2020
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-019-01534-6

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