Intensity-Modulated Radiotherapy (IMRT) vs Helical Tomotherapy (HT) in Concurrent Chemoradiotherapy (CRT) for Patients with Anal Canal Carcinoma (ACC): an analysis of dose distribution and toxicities

Radiation Oncology

Corinne M Doll¹  Kurian Joseph³  Brad Warkentin²  Darren Graham¹  Heather Warkentin²  Yarrow McConnell⁴  Rosanna Yeung¹ 

[1] Department Oncology, Division of Radiation Oncology, University of Calgary, Tom Baker Cancer Center Calgary, 1331- 29th Street NW, Calgary T2N4N2, Alberta, Canada;Department of Oncology, Division of Medical Physics, Cross Cancer Institute, University of Alberta, 11560 University Ave NW, Edmonton T6G 1Z2, Alberta, Canada;Department of Oncology, Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, 11560 University Ave NW, Edmonton T6G 1Z2, Alberta, Canada;Department of Surgery, University of Calgary, Foothills Medical Center, North Tower 10th Floor,1403- 29th Street NW, Calgary T2N 2T9, Alberta, Canada

关键词: Toxicities;    Dosimetry;    Intensity modulated radiotherapy;    Tomotherapy;    Anal cancer;   

Others  :  1177384
DOI  :  10.1186/s13014-015-0398-4

 received in 2014-12-15, accepted in 2015-03-31,  发布年份 2015

【 摘 要 】

Purpose

Intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) have been adopted for radiotherapy treatment of anal canal carcinoma (ACC) due to better conformality, dose homogeneity and normal-tissue sparing compared to 3D-CRT. To date, only one published study compares dosimetric parameters of IMRT vs HT in ACC, but there are no published data comparing toxicities. Our objectives were to compare dosimetry and toxicities between these modalities.

Methods and materials

This is a retrospective study of 35 ACC patients treated with radical chemoradiotherapy at two tertiary cancer institutions from 2008–2010. The use of IMRT vs HT was primarily based on center availability. The majority of patients received fluorouracil (5-FU) and 1–2 cycles of mitomycin C (MMC); 2 received 5-FU and cisplatin. Primary tumor and elective nodes were prescribed to ≥54Gy and ≥45Gy, respectively. Patients were grouped into two cohorts: IMRT vs HT. The primary endpoint was a dosimetric comparison between the cohorts; the secondary endpoint was comparison of toxicities.

Results

18 patients were treated with IMRT and 17 with HT. Most IMRT patients received 5-FU and 1 MMC cycle, while most HT patients received 2 MMC cycles (p < 0.01), based on center policy. HT achieved more homogenous coverage of the primary tumor (HT homogeneity and uniformity index 0.14 and 1.02 vs 0.29 and 1.06 for IMRT, p = 0.01 and p < 0.01). Elective nodal coverage did not differ. IMRT achieved better bladder, femoral head and peritoneal space sparing (V30 and V40, p ≤ 0.01), and lower mean skin dose (p < 0.01). HT delivered lower bone marrow (V10, p < 0.01) and external genitalia dose (V20 and V30, p < 0.01). Grade 2+ hematological and non-hematological toxicities were similar. Febrile neutropenia and unscheduled treatment breaks did not differ (both p = 0.13), nor did 3-year overall and disease-free survival (p = 0.13, p = 0.68).

Conclusions

Chemoradiotherapy treatment of ACC using IMRT vs HT results in differences in dose homogenity and normal-tissue sparing, but no significant differences in toxicities.

【 授权许可】

   
2015 Yeung et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

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