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Intensity-modulated radiation therapy (IMRT) with concurrent chemotherapy for anal cancers: Acute toxicity profile and avoidance of a treatment break



Intensity-modulated radiation therapy (IMRT) with concurrent chemotherapy for anal cancers: Acute toxicity profile and avoidance of a treatment break



Journal of Clinical Oncology 26(15_Suppl): 15593-15593



NlmCategory="UNASSIGNED">15593 Background: IMRT allows delivery of a radiation (RT) dose distribution that conforms to the shape of complex or multiple targets and avoidance structures as in anal cancer. The improvement in dose distribution may reduce the acute toxicity of this treatment program, but data demonstrating this are lacking. We studied our initial experience with IMRT with concurrent chemotherapy for tumors of the anal canal or anorectum to determine the severity and frequency of toxicities and whether completion of therapy was compromised or enabled by use of complex RT planning. 15 patients (pts) with ≥ T3 or LN+ tumors of the anorectum received IMRT with concurrent chemotherapy (CT). Tumor and elective volume doses were 5400-5940 cGy (216-212.1 per fraction) and 4500-4760 cGy (180- 170 per fraction). 11 pts had squamous histology. 4 pts with adenocarcinoma who refused surgery were treated definitively. CT consisted of 5FU and either Cisplatinum (7), Mitomycin C (4), or 5FU or Capecitabine alone (4) at standard doses. Local and systemic toxicities were scored weekly during treatment, and at 3 month intervals in the 1st year therafter using the NCI CTCAE v.3.0 scoring system. The % of pts with ≥ G2 skin, hematologic (heme.), and GI toxicity was 47, 67, and 87%, 1st occurring on average at 5.3, 4.3, and 3.4 weeks respectively. There were no G3 skin toxicities, and 1 G3 GI toxicity. 6 pts (40%) had ≥ G3 non-anemia heme. toxicity; 4 of 6 received Mitomcycin C. Notably, only 1 pt required a treatment break (3d) due to acute toxicity. No pts had CT reduced or delayed because of RT toxicity. Mean wt. loss was 5.0%, and no pts lost more than 10 %. 47% reported G1 fatigue. 1 pt developed G1 leg lymphedema after treatment, and 1 had persistent G2 diarrhea. IMRT for anorectal tumors had a favorable toxicity profile, despite delivery of higher than standard daily RT tumor doses. This is distinct from the expectation that 40-70 % of pts will require a treatment break due to acute toxicities with standard RT. The results are favorable compared with toxicities in completed phase III studies with conventional RT. These results are encouraging, as treatment breaks may compromise efficacy and negate potential benefits of efforts to augment standard therapy. No significant financial relationships to disclose.

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Accession: 058133024

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PMID: 27947230


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