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Volumetric intensity-modulated arc therapy vs. 3-dimensional conformal radiotherapy for primary chemoradiotherapy of anal carcinoma

Effects on treatment-related side effects and survival

Volumetrisch modulierte Rotationstherapie vs. 3-dimensionale konformale Radiotherapie in der primären Radiochemotherapie von Analkarzinomen

Auswirkungen auf Nebenwirkungen und Überleben

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Abstract

Background

Primary chemoradiotherapy (CRT) is the standard treatment for locally advanced anal carcinoma. This study compared volumetric intensity-modulated arc therapy (VMAT) to 3-dimensional conformal radiotherapy (3DCRT) in terms of treatment-related side effects and survival.

Patients and methods

From 1992–2014, 103 consecutive patients with anal carcinoma UICC stage I–III were treated. Concomitant CRT consisted of whole pelvic irradiation, including the iliac and inguinal lymph nodes, with 50.4 Gy (1.8 Gy per fractions) by VMAT (n = 17) or 3DCRT (n = 86) as well as two cycles of 5-fluorouracil and mitomycin C. Acute organ and hematological toxicity were assessed according to the Common Terminology Criteria (CTC) for Adverse Events version 3.0. Side effects ≥ grade 3 were scored as high-grade toxicity.

Results

High-grade acute organ toxicity CTC ≥ 3 (P < 0.05), especially proctitis (P = 0.03), was significantly reduced in VMAT patients. The 2-year locoregional control (LRC) and disease-free survival (DFS) were both 100 % for VMAT patients compared with 80 and 73 % for 3DCRT patients.

Conclusion

VMAT was shown to be a feasible technique, achieving significantly lower rates of acute organ toxicity and promising results for LRC and DFS. Future investigations will aim at assessing the advantages of VMAT with respect to late toxicity and survival after a prolonged follow-up time.

Zusammenfassung

Hintergrund

Die primäre Radiochemotherapie (RCT) gilt als Standardtherapie für lokal fortgeschrittene Analkarzinome. In dieser Studie wurde die volumetrisch modulierte Rotationstherapie („volumetric intensity-modulated arc therapy“, VMAT) mit der klassischen dreidimensionalen konformalen Radiotherapie (3DCRT) hinsichtlich therapieassoziierter Nebenwirkungen und Überleben verglichen.

Methoden

Von 1992–2014 wurden 103 aufeinanderfolgende Patienten mit einem Analkarzinom im UICC-Stadium I–III behandelt. Die kombinierte RCT bestand aus der Bestrahlung des gesamten Beckens inklusive der iliakalen und der inguinalen Lymphknoten mit einer Gesamtdosis von 50,4 Gy (1,8 Gy pro Fraktion) entweder mit VMAT (n = 17) oder 3DCRT (n = 86) sowie zwei begleitenden Chemotherapiezyklen mit 5-Fluorouracil und Mitomycin C. Alle akuten Organ- und/oder hämatologischen Nebenwirkungen wurden gemäß der Common Terminology Criteria (CTC) for Adverse Events Version 3.0 erfasst. Nebenwirkungen ≥ Grad 3 wurden als hochgradige Toxizität gewertet.

Ergebnisse

Die VMAT-Patienten entwickelten insgesamt signifikant weniger hochgradige (CTC ≥ 3) Akutnebenwirkungen an den Organen bzw. im gesunden Gewebe (P < 0,05), insbesondere die Proktitis (P = 0,03) war verringert. Die lokoregionäre Tumorkontrolle (LRC) und das erkrankungsfreie Überleben (DFS) lagen nach 2 Jahren bei 100 % für alle VMAT-Patienten verglichen mit 80 und 73 % für die 3DCRT-Patienten.

Schlussfolgerung

VMAT hat sich als eine praktikable Radiotherapietechnik bewiesen, die signifikant niedrigere Raten an akuter Organtoxizität und vielversprechende LRC- und DFS-Ergebnisse zeigt. Zukünftige Untersuchungen sollten darauf abzielen, die Vorteile von VMAT in Hinblick auf die Spättoxizität und das Langzeitüberleben zu analysieren.

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Acknowledgments

This manuscript was edited by the “American Journal Experts” editorial service. The results of this manuscript were presented as a poster presentation at the annual meeting of the DEGRO 2014 in Düsseldorf, Germany.

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Authors and Affiliations

  1. Dept. of Radiotherapy and Radiooncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany

    Hanne Elisabeth Weber M.D.,  Leif Hendrik Dröge M.D.,  Steffen Hennies M.D.,  Markus Karl Herrmann M.D. &  Hendrik Andreas Wolff M.D.

  2. Dept. of General Surgery, University Medical Center Göttingen, Göttingen, Germany

    Jochen Gaedcke M.D.

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  1. Hanne Elisabeth Weber M.D.
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  2. Leif Hendrik Dröge M.D.
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  5. Jochen Gaedcke M.D.
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  6. Hendrik Andreas Wolff M.D.
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Correspondence to Hendrik Andreas Wolff M.D..

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Conflict of interest

H.E. Weber, L.H. Dröge, S. Hennies, M.K. Herrmann, J. Gaedcke, and H.A. Wolff state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form).

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Weber, H., Dröge, L., Hennies, S. et al. Volumetric intensity-modulated arc therapy vs. 3-dimensional conformal radiotherapy for primary chemoradiotherapy of anal carcinoma. Strahlenther Onkol 191, 827–834 (2015). https://doi.org/10.1007/s00066-015-0859-6

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