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Optimal Radiotherapy Dose in Anal Cancer: Trends in Prescription Dose and Association with Survival

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Abstract

Purpose

Definitive chemoradiotherapy represents a standard of care treatment for localized anal cancer. National Comprehensive Cancer Network guidelines recommend radiotherapy (RT) doses of ≥ 45 Gy and escalation to 50.4–59 Gy for advanced disease. Per RTOG 0529, 50.4 Gy was prescribed for early-stage disease (cT1-2N0), and 54 Gy for locally advanced cancers (cT3-T4 and/or node positive). We assessed patterns of care and overall survival (OS) with respect to the RT dose.

Methods

The National Cancer Database identified patients with non-metastatic anal squamous cell carcinoma from 2004 to 2015 treated with chemoradiotherapy. Patients were stratified by RT dose: 40–< 45, 45–< 50, 50–54, and > 54–60 Gy. Crude and adjusted hazard ratios (HR) were computed using Cox regression modeling.

Results

A total of 10,524 patients were identified with a median follow-up of 40.7 months. The most commonly prescribed RT dose was 54 Gy. On multivariate analysis, RT doses of 40–< 45 Gy were associated with worse OS vs. 50–54 Gy (HR 1.68 [1.40–2.03], P < 0.0001). There was no significant difference in OS for patients who received 45–< 50 or > 54–60 Gy compared with 50–54 Gy. For early-stage disease, there was no significant association between RT dose and OS. For locally advanced disease, 45–< 54 Gy was associated with worse survival vs. 54 Gy (HR 1.18 [1.04–1.34], P = 0.009), but no significant difference was detected comparing > 54–60 Gy vs. 54 Gy (HR 1.08 [0.97–1.22], P = 0.166).

Conclusions

For patients with localized anal cancer, RT doses of ≥ 45 Gy were associated with improved OS. For locally advanced disease, 54 Gy but not > 54 Gy was associated with improved OS.

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Authors and Affiliations

  1. Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA

    Nishant K. Shah, Muhammad M. Qureshi, Michael A. Dyer, Minh Tam Truong & Kimberley S. Mak

  2. University of Pennsylvania Radiation Oncology Residency Program, 3400 Civic Center Boulevard, Concourse Level, Philadelphia, PA, 19104, USA

    Nishant K. Shah

  3. Department of Radiation Oncology, Boston Medical Center, 830 Harrison Ave, Moakley Building LL 237, Boston, MA, 02118, USA

    Muhammad M. Qureshi, Michael A. Dyer, Minh Tam Truong & Kimberley S. Mak

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Shah, N.K., Qureshi, M.M., Dyer, M.A. et al. Optimal Radiotherapy Dose in Anal Cancer: Trends in Prescription Dose and Association with Survival. J Gastrointest Canc 52, 229–236 (2021). https://doi.org/10.1007/s12029-020-00393-0

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