Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2015

Open Access 01-12-2015 | Research

Intensity-Modulated Radiotherapy (IMRT) vs Helical Tomotherapy (HT) in Concurrent Chemoradiotherapy (CRT) for Patients with Anal Canal Carcinoma (ACC): an analysis of dose distribution and toxicities

Authors: Rosanna Yeung, Yarrow McConnell, Heather Warkentin, Darren Graham, Brad Warkentin, Kurian Joseph, Corinne M Doll

Published in: Radiation Oncology | Issue 1/2015

Login to get access

Abstract

Purpose

Intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) have been adopted for radiotherapy treatment of anal canal carcinoma (ACC) due to better conformality, dose homogeneity and normal-tissue sparing compared to 3D-CRT. To date, only one published study compares dosimetric parameters of IMRT vs HT in ACC, but there are no published data comparing toxicities. Our objectives were to compare dosimetry and toxicities between these modalities.

Methods and materials

This is a retrospective study of 35 ACC patients treated with radical chemoradiotherapy at two tertiary cancer institutions from 2008–2010. The use of IMRT vs HT was primarily based on center availability. The majority of patients received fluorouracil (5-FU) and 1–2 cycles of mitomycin C (MMC); 2 received 5-FU and cisplatin. Primary tumor and elective nodes were prescribed to ≥54Gy and ≥45Gy, respectively. Patients were grouped into two cohorts: IMRT vs HT. The primary endpoint was a dosimetric comparison between the cohorts; the secondary endpoint was comparison of toxicities.

Results

18 patients were treated with IMRT and 17 with HT. Most IMRT patients received 5-FU and 1 MMC cycle, while most HT patients received 2 MMC cycles (p < 0.01), based on center policy. HT achieved more homogenous coverage of the primary tumor (HT homogeneity and uniformity index 0.14 and 1.02 vs 0.29 and 1.06 for IMRT, p = 0.01 and p < 0.01). Elective nodal coverage did not differ. IMRT achieved better bladder, femoral head and peritoneal space sparing (V30 and V40, p ≤ 0.01), and lower mean skin dose (p < 0.01). HT delivered lower bone marrow (V10, p < 0.01) and external genitalia dose (V20 and V30, p < 0.01). Grade 2+ hematological and non-hematological toxicities were similar. Febrile neutropenia and unscheduled treatment breaks did not differ (both p = 0.13), nor did 3-year overall and disease-free survival (p = 0.13, p = 0.68).

Conclusions

Chemoradiotherapy treatment of ACC using IMRT vs HT results in differences in dose homogenity and normal-tissue sparing, but no significant differences in toxicities.
Literature
1.
Nigro ND, Vaitkevicius VK, Buroker T, Bradley GT, Considine B. Combined therapy for cancer of the anal canal. Dis Colon Rectum. 1981;24:73–5.CrossRefPubMed
2.
Nigro ND, Seydel HG, Considine B, Vaitkevicius VK, Leichman L, Kinzie JJ. Combined preoperative radiation and chemotherapy for squamous cell carcinoma of the anal canal. Cancer. 1983;51:1826–9.CrossRefPubMed
3.
Leichman L, Nigro N, Vaitkevicius VK, Considine B, Buroker T, Bradley G, et al. Cancer of the anal canal. Model for preoperative adjuvant combined modality therapy. Am J Med. 1985;78:211–5.CrossRefPubMed
4.
Northover J, Glynne-Jones R, Sebag-Montefiore D, James R, Meadows H, Wan S, et al. Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I). Br J Cancer. 2010;102:1123–8.CrossRefPubMedCentralPubMed
5.
Bartelink H, Roelofsen F, Eschwege F, Rougier P, Bosset JF, Gonzalez DG, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol. 1997;15:2040–9.PubMed
6.
Flam M, John M, Pajak TF, Petrelli N, Myerson R, Doggett S, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol. 1996;14:2527–39.PubMed
7.
Vuong T, Devic S, Belliveau P, Muanza T, Hegyi G. Contribution of conformal therapy in the treatment of anal canal carcinoma with combined chemotherapy and radiotherapy: results of a phase II study. Int J Radiat Oncol Biol Phys. 2003;56:823–31.CrossRefPubMed
8.
Salama JK, Mell LK, Schomas DA, Miller RC, Devisetty K, Jani AB, et al. Concurrent chemotherapy and intensity-modulated radiation therapy for anal canal cancer patients: a multicenter experience. J Clin Oncol. 2007;25:4581–6.CrossRefPubMed
9.
Gunderson LL, Winter KA, Ajani JA, Pedersen JE, Moughan J, Benson AB, et al. Long-term update of U.S. GI Intergroup RTOG 98–11 phase III trial for anal carcinoma: survival, relapse and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomycin versus fluroruracil/cisplatin. J Clin Oncol. 2012;30:4344–51.CrossRefPubMedCentralPubMed
10.
James RD, Glynne-Jones R, Meadows HM, Cunningham D, Myint AS, Saunders MP, et al. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomized, phase 3, open-label, 2x2 factorial trial. Lancet Oncol. 2013;14:516–24.CrossRefPubMed
11.
Kachnic LA, Winter K, Myerson RJ, Goodyear MD, Willins J, Esthappan J, et al. RTOG 0529: a phase 2 evaluation of dose-painted intensity-modulated radiation therapy in combination with 5-fluroruracil and mitomycin-c for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys. 2013;86:27–33.CrossRefPubMedCentralPubMed
12.
Lian J, Mackenzie M, Joseph K, Pervez N, Dundas G, Urtasun R, et al. Assessment if extended-field radiotherapy for stage IIIc endometrial cancer using three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and helical tomotherapy. Int J Radiat Oncol Biol Phys. 2008;70:935–43.CrossRefPubMed
13.
Skórska M, Piotrowski T, Kaźmierska J, Adamska K. A dosimetric comparison of IMRT versus helical tomotherapy for brain tumors. Physica Medica. 2014;29:221–3.
14.
Joseph K, Syme A, Small C, Warkentin H, Quon H, Ghosh S, et al. A treatment planning study comparing helical tomotherapy with intensity-modulated radiotherapy for the treatment of anal cancer. Radiother Oncol. 2010;94:60–6.CrossRefPubMed
15.
Cox JD, Stetz J, Pajak TF. Toxicity criteria for the radiation therapy oncology group (RTOG) and the European Organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341-46.
16.
Roeske JC, Lujan A, Reba RC, Penney BC, Diane Yamada S, Mundt AJ. Incorporation of SPECT bone marrow imaging into intensity-modulated whole-pelvis radiation therapy treatment planning for gynecologic malignancies. Radiother Oncol. 2005;77:11–7.CrossRefPubMed
17.
Liang Y, Bydder M, Yashar CM, Rose BS, Cornell M, Hoh CK, et al. Prospective Study of functional bone marrow-sparing intensity-modulated radiation therapy with concurrent chemotherapy for pelvic malignancies. Int J Radiat Oncol Biol Phys. 2013;85:406–14.CrossRefPubMed
18.
Wang X, Zhang X, Dong L, Liu H, Gillin M, Ahamad A, et al. Effectiveness of noncoplanar IMRT planning using a parallelized multiresolution beam angle optimization method for paranasal sinus carcinoma. Int J Radiat Oncol Biol Phys. 2005;63:594–601.CrossRefPubMed
19.
Iori M, Cattaneo GM, Cagni E, Fiorino C, Borasi G, Riccardo C, et al. Dose-volume and biological-model based comparison between helical tomotherapy and (inverse-planned) IMAT for prostate tumours. Radiother Oncol. 2008;88:34–45.CrossRefPubMed
20.
Eng C, Chang GJ, You YN, Das P, Xing Y, Delclos M, et al. Long-term results of weekly/daily cisplatin-based chemoradiation for locally advanced squamous cell carcinoma of the anal canal. Cancer. 2013;119:3769–75.CrossRefPubMed
21.
Olivatto LO, Cabral V, Rosa A, Bezerra M, Santarem E, Fassizoli A, et al. Mitomycin-C- or cisplatin-based chemoradiotherapy for anal canal carcinoma: long term results. Int J Radiat Oncol Biol Phys. 2011;79:490–5.CrossRefPubMed
22.
Tan YI, Metwaly M, Glegg M, Baggarley S, Elliott A. Evaluation of six TPS algorithms in computing entrance and exit doses. J Appl Clin Med Phy. 2014;15:229–40.
23.
Capelle L, Warkentin H, Mackenzie M, Joseph K, Gabos Z, Pervez N, et al. Skin-sparing Helical Tomotherapy vs 3D-conformal radiotherapy for adjuvant breast radiotherapy: in vivo skin dosimetry study. Int J Radiat Oncol Biol Phys. 2012;83:583–90.CrossRef
24.
Yeung R, McConnell Y, Roxin G, Banerjee R, Urgoiti GB, MacLean AR, et al. One vs two cycles of mitomycin C in chemoradiotherapy for anal cancer: analysis of outcomes and toxicity. Curr Oncol. 2014;21:449–56.CrossRef
Metadata
Title
Intensity-Modulated Radiotherapy (IMRT) vs Helical Tomotherapy (HT) in Concurrent Chemoradiotherapy (CRT) for Patients with Anal Canal Carcinoma (ACC): an analysis of dose distribution and toxicities
Authors
Rosanna Yeung
Yarrow McConnell
Heather Warkentin
Darren Graham
Brad Warkentin
Kurian Joseph
Corinne M Doll
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-015-0398-4

Other articles of this Issue 1/2015

Radiation Oncology 1/2015 Go to the issue

Research

Adjuvant radiation therapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials- an update

Research

Definitive intensity modulated radiotherapy in locally advanced hypopharygeal and laryngeal squamous cell carcinoma: mature treatment results and patterns of locoregional failure

Research

Regional hyperthermia of the abdomen, a pilot study towards the treatment of peritoneal carcinomatosis

Research

Reproducibility of deep inspiration breath hold for prone left-sided whole breast irradiation

Research

Determination of the optimal matching position for setup images and minimal setup margins in adjuvant radiotherapy of breast and lymph nodes treated in voluntary deep inhalation breath-hold

Research

Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer