High-Dose Split-Course Radiation Therapy for Anal Cancer: Outcome Analysis Regarding the Boost Strategy (CORS-03 Study)

Journal Article · Fri Jul 01 00:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.02.055· OSTI ID:21587564

Hannoun-Levi, Jean-Michel ^[1]; Ortholan, Cecile ^[1]; Resbeut, Michel ^[2]; Teissier, Eric ^[3]; Ronchin, Philippe ^[3]; Cowen, Didier ^[4]; Zaccariotto, Audrey ^[4]; Benezery, Karen; Francois, Eric ^[1]; Salem, Naji ^[5]; Ellis, Steve ^[6]; Azria, David ^[7]; Gerard, Jean-Pierre ^[1]

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1. Antoine Lacassagne Cancer Center, Nice (France)
2. French Red Cross, Toulon (France)
3. Azurean Cancer Center, Mougins (France)
4. Timone Academic Hospital, Marseille (France)
5. Paoli Calmette Institut, Marseille (France)
6. Catalan Oncology Center, Perpignan (France)
7. Val d'Aurelle Cancer Center, Montpellier (France)

Purpose: To retrospectively assess the clinical outcome in anal cancer patients treated with split-course radiation therapy and boosted through external-beam radiation therapy (EBRT) or brachytherapy (BCT). Methods and Materials: From January 2000 to December 2004, a selected group (162 patients) with invasive nonmetastatic anal squamous cell carcinoma was studied. Tumor staging reported was T1 = 31 patients (19%), T2 = 77 patients (48%), T3 = 42 patients (26%), and T4= 12 patients (7%). Lymph node status was N0-1 (86%) and N2-3 (14%). Patients underwent a first course of EBRT: mean dose 45.1 Gy (range, 39.5-50) followed by a boost: mean dose 17.9 Gy (range, 8-25) using EBRT (76 patients, 47%) or BCT (86 patients, 53%). All characteristics of patients and tumors were well balanced between the BCT and EBRT groups. Results: The mean overall treatment time (OTT) was 82 days (range, 45-143) and 67 days (range, 37-128) for the EBRT and BCT groups, respectively (p < 0.001). The median follow-up was 62 months (range, 2-108). The 5-year cumulative rate of local recurrence (CRLR) was 21%. In the univariate analysis, the prognostic factors for CRLR were as follows: T stage (T1-2 = 15% vs. T3-4 = 36%, p = 0.03), boost technique (BCT = 12% vs. EBRT = 33%, p = 0.002) and OTT (OTT <80 days = 14%, OTT {>=}80 days = 34%, p = 0.005). In the multivariate analysis, BCT boost was the unique prognostic factor (hazard ratio = 0.62 (0.41-0.92). In the subgroup of patients with OTT <80 days, the 5-year CRLR was significantly increased with the BCT boost (BC = 9% vs. EBRT = 28%, p = 0.03). In the case of OTT {>=}80 days, the 5-year CRLR was not affected by the boost technique (BCT = 29% vs. EBRT = 38%, p = 0.21). Conclusion: In anal cancer, when OTT is <80 days, BCT boost is superior to EBRT boost for CRLR. These results suggest investigating the benefit of BCT boost in prospective trials.

• OSTI ID: 21587564
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 80, Issue 3; Other Information: DOI: 10.1016/j.ijrobp.2010.02.055; PII: S0360-3016(10)00442-6; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
BRACHYTHERAPY
CARCINOMAS
LYMPH NODES
MULTIVARIATE ANALYSIS
RADIATION DOSES
RECTUM
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DIGESTIVE SYSTEM
DISEASES
DOSES
GASTROINTESTINAL TRACT
INTESTINES
LARGE INTESTINE
LYMPHATIC SYSTEM
MATHEMATICS
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NUCLEAR MEDICINE
ORGANS
RADIOLOGY
RADIOTHERAPY
STATISTICS
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