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Role of brachytherapy in the treatment of cancers of the anal canal

Long-term follow-up and multivariate analysis of a large monocentric retrospective series

Stellenwert der Brachytherapie bei der Behandlung von Tumoren des Analkanals

Langzeit-Follow-up und multivariate Analyse einer großen monozentrischen, retrospektiven Studie

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Abstract

Background and purpose

There are few data on long-term clinical results and tolerance of brachytherapy in anal canal cancer. We present one of the largest retrospective analyses of anal canal cancers treated with external beam radiotherapy with/without (±) chemotherapy followed by a brachytherapy boost.

Materials and methods

We performed a retrospective analysis of clinical results in terms of efficacy and toxicity. The impact of different clinical and therapeutic variables on these outcomes was studied.

Results

From May 1992 to December 2009, 209 patients received brachytherapy after external beam radiotherapy ± chemotherapy. Of these patients, 163 were stage II or stage IIIA (UICC 2002) and 58 were N1-3. According to age, ECOG performance status (PS), and comorbidities, patients received either radiotherapy alone (58/209) or radiochemotherapy (151/209). The median follow-up was 72.8 months. The 5- and 10-year local control rates were 78.6 and 73.9 %, respectively. Globally, severe acute and late G3–4 reactions (NCI-CTC scale v. 4.0) occurred in 11.2 and 6.3 % of patients, respectively. Univariate analysis showed the statistical impact of the pelvic treatment volume (p = 0.046) and of the total dose (p = 0.02) on the risk of severe acute and late toxicities, respectively. Only six patients required permanent colostomy because of severe late anorectal toxicities.

Conclusion

After a long follow-up time, brachytherapy showed an acceptable toxicity profile and high local control rates in patients with anal canal cancer.

Zusammenfassung

Hintergrund und Ziel

Es gibt gegenwärtig nur wenige klinische Daten zu den Ergebnissen und Nebenwirkungen von Brachytherapie bei Analkanaltumoren. Wir präsentieren die Daten einer der größten retrospektiven Auswertungen für die Behandlung von Analkanaltumoren mit perkutaner Radiotherapie ± simultaner Chemotherapie, gefolgt von einem Brachytherapie-Boost.

Material und Methoden

Wir analysierten retrospektiv die Patientendaten hinsichtlich Toxizität und Tumorkontrolle. Der Einfluss verschiedener klinischer und therapeutischer Variablen auf das Outcome der Patienten wurde untersucht.

Ergebnisse

Zwischen Mai 1992 und Dezember 2009 erhielten 209 Patienten eine Brachytherapie nach perkutaner Strahlentherapie ± simultaner Chemotherapie. Hiervon waren 163 Patienten Stadium II oder IIIA (UICC 2002) und 58 N1-3. Entsprechend ihres Alters, ECOG-Status und Komorbiditäten erhielten die Patienten entweder eine alleinige Strahlentherapie (58/209) oder eine kombinierte Radiochemotherapie (151/209). Die mediane Nachbeobachtungszeit lag bei 72,8 Monaten. Die lokale Kontrolle nach 5 bzw. 10 Jahren lag bei 78,6 % bzw. 73,9 %. Schwere akute bzw. chronische Therapienebenwirkungen (G3-G4 nach NCI-CTC-Scale v. 4.0) traten in 11,2 % bzw. 6,3 % der Fälle auf. Univariate Analysen zeigten einen Einfluss des pelvinen Bestrahlungsvolumens (p = 0,046) und der Gesamtdosis(p = 0,02) für das Risiko, schwerwiegende akute oder chronische Nebenwirkungen zu entwickeln. Lediglich 6/209 Patienten benötigten die Anlage eines dauerhaften Kolostomas aufgrund schwerwiegender anorektaler Toxizitäten.

Schlussfolgerung

Nach langer Nachsorgezeit zeigte die Brachytherapie bei Analkanaltumoren ein akzeptables Nebenwirkungsprofil bei hoher lokaler Kontrolle.

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Conflict of interest

L. Lestrade, B. De Bari, P. Pommier, X. Montbarbon, E. Lavergne, J.-M. Ardiet, and C. Carrie state that there are no conflicts of interest.

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Authors and Affiliations

  1. Radiation Oncology, Léon Bérard Cancer Center, Lyon, France

    Laëtitia Lestrade MD, Pascal Pommier MD, PhD, Xavier Montbarbon MD & Christian Carrie MD

  2. Radiation Oncology, Centre hospitalier universitaire vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Berardino De Bari MD

  3. Unité de Biostatistique et d’Evaluation des Thérapeutiques, Léon Bérard Cancer Center, Lyon, France

    Emilie Lavergne

  4. Radiation Oncology, Centre Hospitalier Lyon Sud, Lyon, France

    Jean-Michel Ardiet MD

Authors
  1. Laëtitia Lestrade MD
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  2. Berardino De Bari MD
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  3. Pascal Pommier MD, PhD
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  4. Xavier Montbarbon MD
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  5. Emilie Lavergne
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  6. Jean-Michel Ardiet MD
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  7. Christian Carrie MD
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Correspondence to Berardino De Bari MD.

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Lestrade, L., De Bari, B., Pommier, P. et al. Role of brachytherapy in the treatment of cancers of the anal canal. Strahlenther Onkol 190, 546–554 (2014). https://doi.org/10.1007/s00066-014-0628-y

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  • DOI: https://doi.org/10.1007/s00066-014-0628-y

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