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Squamous cell carcinoma of the anal canal: patterns and predictors of failure and implications for intensity-modulated radiation treatment planning.
Int J Radiat Oncol Biol Phys. 2010 Nov 15; 78(4):1064-72.IJ

Abstract

PURPOSE

Intensity-modulated radiation treatment (IMRT) is increasingly used in the treatment of squamous cell carcinoma of the anal canal (SCCAC). Prevention of locoregional failure (LRF) using IMRT requires appropriate clinical target volume (CTV) definition. To better define the CTV for IMRT, we evaluated patterns and predictors of LRF in SCCAC patients given conventional radiation treatment.

METHODS AND MATERIALS

We reviewed records of 180 SCCAC patients treated with conventional radiation with or without chemotherapy at our institution between January 1990 and March 2007. All patients received radiation; the median primary tumor dose was 45 Gy. A total of 173 patients also received mitomycin-based chemotherapy.

RESULTS

Median follow-up was 40 months. Actuarial 3-year colostomy-free survival was 89% and overall survival (OS) 88%. Actuarial 3-year LRF was 23%. A total of 45 patients had LRF, with 35 (78%) occurring locally in the primary site (25 local only, 10 local and regional); however, 20 (44%) had regional components of failure within the pelvis or inguinal nodes (10 regional only, 10 local and regional). Cumulative sites of LRF (patients may have one or more site of failure) were as follows: primary, 35; inguinal, 8; external perianal, 5; common iliac, 4; presacral, 3; distal rectum, 2; external iliac, 2; and internal iliac, 2. All patients with common iliac failure had cT3 or N+ disease.

CONCLUSIONS

The observed patterns of failure support inclusion of the inguinal and all pelvic nodal groups in the CTV for IMRT. In patients with advanced tumor or nodal stage, common iliac nodes should also be included in the CTV.

Authors+Show Affiliations

Department of Radiation Oncology, University of Miami, Miami, FL 33133, USA. jwright3@med.miami.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20350793

Citation

Wright, Jean L., et al. "Squamous Cell Carcinoma of the Anal Canal: Patterns and Predictors of Failure and Implications for Intensity-modulated Radiation Treatment Planning." International Journal of Radiation Oncology, Biology, Physics, vol. 78, no. 4, 2010, pp. 1064-72.
Wright JL, Patil SM, Temple LK, et al. Squamous cell carcinoma of the anal canal: patterns and predictors of failure and implications for intensity-modulated radiation treatment planning. Int J Radiat Oncol Biol Phys. 2010;78(4):1064-72.
Wright, J. L., Patil, S. M., Temple, L. K., Minsky, B. D., Saltz, L. B., & Goodman, K. A. (2010). Squamous cell carcinoma of the anal canal: patterns and predictors of failure and implications for intensity-modulated radiation treatment planning. International Journal of Radiation Oncology, Biology, Physics, 78(4), 1064-72. https://doi.org/10.1016/j.ijrobp.2009.09.029
Wright JL, et al. Squamous Cell Carcinoma of the Anal Canal: Patterns and Predictors of Failure and Implications for Intensity-modulated Radiation Treatment Planning. Int J Radiat Oncol Biol Phys. 2010 Nov 15;78(4):1064-72. PubMed PMID: 20350793.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Squamous cell carcinoma of the anal canal: patterns and predictors of failure and implications for intensity-modulated radiation treatment planning. AU - Wright,Jean L, AU - Patil,Sujata M, AU - Temple,Larissa K F, AU - Minsky,Bruce D, AU - Saltz,Leonard B, AU - Goodman,Karyn A, Y1 - 2010/03/29/ PY - 2009/06/19/received PY - 2009/09/16/revised PY - 2009/09/18/accepted PY - 2010/3/31/entrez PY - 2010/3/31/pubmed PY - 2010/11/11/medline SP - 1064 EP - 72 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 78 IS - 4 N2 - PURPOSE: Intensity-modulated radiation treatment (IMRT) is increasingly used in the treatment of squamous cell carcinoma of the anal canal (SCCAC). Prevention of locoregional failure (LRF) using IMRT requires appropriate clinical target volume (CTV) definition. To better define the CTV for IMRT, we evaluated patterns and predictors of LRF in SCCAC patients given conventional radiation treatment. METHODS AND MATERIALS: We reviewed records of 180 SCCAC patients treated with conventional radiation with or without chemotherapy at our institution between January 1990 and March 2007. All patients received radiation; the median primary tumor dose was 45 Gy. A total of 173 patients also received mitomycin-based chemotherapy. RESULTS: Median follow-up was 40 months. Actuarial 3-year colostomy-free survival was 89% and overall survival (OS) 88%. Actuarial 3-year LRF was 23%. A total of 45 patients had LRF, with 35 (78%) occurring locally in the primary site (25 local only, 10 local and regional); however, 20 (44%) had regional components of failure within the pelvis or inguinal nodes (10 regional only, 10 local and regional). Cumulative sites of LRF (patients may have one or more site of failure) were as follows: primary, 35; inguinal, 8; external perianal, 5; common iliac, 4; presacral, 3; distal rectum, 2; external iliac, 2; and internal iliac, 2. All patients with common iliac failure had cT3 or N+ disease. CONCLUSIONS: The observed patterns of failure support inclusion of the inguinal and all pelvic nodal groups in the CTV for IMRT. In patients with advanced tumor or nodal stage, common iliac nodes should also be included in the CTV. SN - 1879-355X UR - https://www.unboundmedicine.com/medline/citation/20350793/Squamous_cell_carcinoma_of_the_anal_canal:_patterns_and_predictors_of_failure_and_implications_for_intensity_modulated_radiation_treatment_planning_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(09)03271-4 DB - PRIME DP - Unbound Medicine ER -