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Long-term results of chemoradiation plus pulsed-dose-rate brachytherapy boost in anal canal carcinoma: A mono-institutional retrospective analysis

PURPOSE: Concurrent chemoradiation (CCRT) is the standard curative treatment of anal canal cancer (ACC). The role of a brachytherapy (BRT) boost in this setting is still debated. Therefore, the aim of this analysis was to retrospectively evaluate the clinical outcomes in a large cohort of ACC patien...

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Autores principales: Arcelli, Alessandra, Buwenge, Milly, Macchia, Gabriella, Cammelli, Silvia, Deodato, Francesco, Cilla, Savino, Galuppi, Andrea, Panni, Valeria, Mattiucci, Gian Carlo, Tagliaferri, Luca, Morganti, Alessio G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Termedia Publishing House 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431102/
https://www.ncbi.nlm.nih.gov/pubmed/30911306
http://dx.doi.org/10.5114/jcb.2019.82804
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author Arcelli, Alessandra
Buwenge, Milly
Macchia, Gabriella
Cammelli, Silvia
Deodato, Francesco
Cilla, Savino
Galuppi, Andrea
Panni, Valeria
Mattiucci, Gian Carlo
Tagliaferri, Luca
Morganti, Alessio G.
author_facet Arcelli, Alessandra
Buwenge, Milly
Macchia, Gabriella
Cammelli, Silvia
Deodato, Francesco
Cilla, Savino
Galuppi, Andrea
Panni, Valeria
Mattiucci, Gian Carlo
Tagliaferri, Luca
Morganti, Alessio G.
author_sort Arcelli, Alessandra
collection PubMed
description PURPOSE: Concurrent chemoradiation (CCRT) is the standard curative treatment of anal canal cancer (ACC). The role of a brachytherapy (BRT) boost in this setting is still debated. Therefore, the aim of this analysis was to retrospectively evaluate the clinical outcomes in a large cohort of ACC patients treated with CCRT plus BRT boost or external beam radiotherapy (EBRT) boost. MATERIAL AND METHODS: Patients with non-metastatic ACC, treated in our department between January 2003 and December 2014 were included in this analysis. The initial treatment was based on EBRT to the pelvis (prescribed dose, 45 Gy/1.8 Gy) plus concurrent chemotherapy (5-fluorouracil and mitomycin-C). Patients received a pulsed-dose-rate BRT boost on the primary tumor (median dose, 20 Gy; range, 13-25 Gy) 2-3 weeks after the end of CCRT. In patients with contraindications to BRT, an EBRT boost (prescribed dose, 16 Gy, 2 Gy/fraction) was delivered immediately after CCRT. RESULTS: One-hundred-twenty-three patients were included in this analysis (median age, 61 years; range, 36-93 years; squamous-cell carcinoma, 78%; HIV+, 6%; median follow-up, 71 months; range, 2-158 months). The actuarial 5-year local control (LC), distant metastasis-free survival, colostomy-free survival, and overall survival (OS) rates were 81.7%, 92.3%, 62.3%, and 74.0%, respectively. At univariate analysis, patients aged ≤ 65 years (p < 0.010), cT1-2 stage (p = 0.004), and receiving a BRT boost (p = 0.015) showed significantly improved OS. At multivariate analysis, advanced tumor stage cT3-cT4 (HR, 2.12; 95% CI: 1.09-4.14; p = 0.027), and age > 65 years (HR, 3.03; 95% CI: 1.54-5.95; p = 0.001) significantly predicted increased risk of mortality. The crude rate of toxicity-related colostomies was 4.9%. CONCLUSIONS: The role of BRT boost in ACC remains unclear since the outcomes were not clearly different compared to CCRT alone. However, further improvement of clinical results in ACC treatment is needed, and therefore prospective trials based on advanced (image-guided/adapted) BRT techniques are warranted.
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spelling pubmed-64311022019-03-25 Long-term results of chemoradiation plus pulsed-dose-rate brachytherapy boost in anal canal carcinoma: A mono-institutional retrospective analysis Arcelli, Alessandra Buwenge, Milly Macchia, Gabriella Cammelli, Silvia Deodato, Francesco Cilla, Savino Galuppi, Andrea Panni, Valeria Mattiucci, Gian Carlo Tagliaferri, Luca Morganti, Alessio G. J Contemp Brachytherapy Original Paper PURPOSE: Concurrent chemoradiation (CCRT) is the standard curative treatment of anal canal cancer (ACC). The role of a brachytherapy (BRT) boost in this setting is still debated. Therefore, the aim of this analysis was to retrospectively evaluate the clinical outcomes in a large cohort of ACC patients treated with CCRT plus BRT boost or external beam radiotherapy (EBRT) boost. MATERIAL AND METHODS: Patients with non-metastatic ACC, treated in our department between January 2003 and December 2014 were included in this analysis. The initial treatment was based on EBRT to the pelvis (prescribed dose, 45 Gy/1.8 Gy) plus concurrent chemotherapy (5-fluorouracil and mitomycin-C). Patients received a pulsed-dose-rate BRT boost on the primary tumor (median dose, 20 Gy; range, 13-25 Gy) 2-3 weeks after the end of CCRT. In patients with contraindications to BRT, an EBRT boost (prescribed dose, 16 Gy, 2 Gy/fraction) was delivered immediately after CCRT. RESULTS: One-hundred-twenty-three patients were included in this analysis (median age, 61 years; range, 36-93 years; squamous-cell carcinoma, 78%; HIV+, 6%; median follow-up, 71 months; range, 2-158 months). The actuarial 5-year local control (LC), distant metastasis-free survival, colostomy-free survival, and overall survival (OS) rates were 81.7%, 92.3%, 62.3%, and 74.0%, respectively. At univariate analysis, patients aged ≤ 65 years (p < 0.010), cT1-2 stage (p = 0.004), and receiving a BRT boost (p = 0.015) showed significantly improved OS. At multivariate analysis, advanced tumor stage cT3-cT4 (HR, 2.12; 95% CI: 1.09-4.14; p = 0.027), and age > 65 years (HR, 3.03; 95% CI: 1.54-5.95; p = 0.001) significantly predicted increased risk of mortality. The crude rate of toxicity-related colostomies was 4.9%. CONCLUSIONS: The role of BRT boost in ACC remains unclear since the outcomes were not clearly different compared to CCRT alone. However, further improvement of clinical results in ACC treatment is needed, and therefore prospective trials based on advanced (image-guided/adapted) BRT techniques are warranted. Termedia Publishing House 2019-02-28 2019-02 /pmc/articles/PMC6431102/ /pubmed/30911306 http://dx.doi.org/10.5114/jcb.2019.82804 Text en Copyright: © 2019 Termedia Sp. z o. o. http://creativecommons.org/licenses/by-nc-sa/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
spellingShingle Original Paper
Arcelli, Alessandra
Buwenge, Milly
Macchia, Gabriella
Cammelli, Silvia
Deodato, Francesco
Cilla, Savino
Galuppi, Andrea
Panni, Valeria
Mattiucci, Gian Carlo
Tagliaferri, Luca
Morganti, Alessio G.
Long-term results of chemoradiation plus pulsed-dose-rate brachytherapy boost in anal canal carcinoma: A mono-institutional retrospective analysis
title Long-term results of chemoradiation plus pulsed-dose-rate brachytherapy boost in anal canal carcinoma: A mono-institutional retrospective analysis
title_full Long-term results of chemoradiation plus pulsed-dose-rate brachytherapy boost in anal canal carcinoma: A mono-institutional retrospective analysis
title_fullStr Long-term results of chemoradiation plus pulsed-dose-rate brachytherapy boost in anal canal carcinoma: A mono-institutional retrospective analysis
title_full_unstemmed Long-term results of chemoradiation plus pulsed-dose-rate brachytherapy boost in anal canal carcinoma: A mono-institutional retrospective analysis
title_short Long-term results of chemoradiation plus pulsed-dose-rate brachytherapy boost in anal canal carcinoma: A mono-institutional retrospective analysis
title_sort long-term results of chemoradiation plus pulsed-dose-rate brachytherapy boost in anal canal carcinoma: a mono-institutional retrospective analysis
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431102/
https://www.ncbi.nlm.nih.gov/pubmed/30911306
http://dx.doi.org/10.5114/jcb.2019.82804
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