Radiotherapy for epidermoid carcinoma of the anus: thirty years' experience
| Autor: | Robert J. Myerson, James W. Fleshman, Robert S. Malayapa, Joel Picus, Parag J. Parikh, Matthew G. Mutch, Ira J. Kodner, Elisa H. Birnbaum, Albert J. Chang, Elesyia D. Outlaw, Perry W. Grigsby, Benjamin R. Tan |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Neoplasms Radiation-Induced Anal Carcinoma medicine.medical_treatment Mitomycin Drug Administration Schedule Hospitals University Neoplasms Multiple Primary Antineoplastic Combined Chemotherapy Protocols HIV Seropositivity medicine Carcinoma Anal cancer Humans Radiology Nuclear Medicine and imaging Radiation treatment planning Radiation Injuries Aged Neoplasm Staging Aged 80 and over Salvage Therapy Univariate analysis Analysis of Variance Radiation Missouri business.industry Radiotherapy Dosage Middle Aged medicine.disease Anus Neoplasms Combined Modality Therapy Surgery Radiation therapy Oncology Epidermoid carcinoma Carcinoma Squamous Cell Female Fluorouracil Neoplasm Recurrence Local business Chemoradiotherapy |
| Zdroj: | International journal of radiation oncology, biology, physics. 75(2) |
| ISSN: | 1879-355X |
| Popis: | Purpose To evaluate the factors associated with disease control and morbidity after radiotherapy for anal carcinoma. Methods and Materials Between 1975 and 2005, 194 patients with localized epidermoid anal carcinoma underwent radiotherapy. Treatment evolved from radiotherapy with or without surgery, to preoperative chemoradiotherapy, to definitive chemoradiotherapy (CRT). The radiotherapy techniques also evolved. Results With a median follow-up of 61 months, 57 patients had persistence or recurrence, 9 of whom were successfully salvaged, resulting in 146 (75%) ultimately free of disease (UNED). Univariate analysis for UNED survival showed a strong association with the T and N stage (5-year UNED rate, 88.5% ± 3.4% for those with Stage T1-T2N0; 70.1% ± 4.2% for Stage T3N0; and 52.7% ± 6.6% for Stage III; p > .001) and mobility on palpation (5-year UNED rate, 89.2% ± 4.6% for those with mobile tumors vs. 59.3% ± 6.1% for those with tethered/fixed tumor; p > .001). No association was found with gender, age, preoperative vs. definitive CRT, or human immunodeficiency virus status. The 20 human immunodeficiency virus+ patients all received CRT. The radiotherapy factors associated with Grade 3 or greater late morbidity included anorectal morbidity with tumor dose (29% with a dose ≥55 Gy vs. 9% otherwise), small bowel injury with technique (9% with anteroposterior–posteroanterior supine vs. 0.7% with multiple fields prone), and bone injury with femoral head dose (9% with a dose of ≥44 Gy vs. 0.7% otherwise). Of the 194 patients, 56 had 68 additional malignancies, mainly either antedating the anal cancer or outside the radiation fields. Conclusion Our results have confirmed that CRT is an effective approach. Patients with human immunodeficiency virus can be treated with CRT. Tumor mobility significantly predicts the outcome; the implications for management are discussed. We also discuss the treatment planning implications of the late morbidity findings. The substantial incidence of additional malignancies underscores the importance of full oncologic screening during follow-up. |
| Databáze: | OpenAIRE |
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