Background
Methods
Patients
3D-CRT (n= 27) | IMRT (n= 24) | Total (n= 51) | p-value Chi2 | ||
---|---|---|---|---|---|
Age
| Median | 36.1 [40.7-92.2] | 59.7 [49.8-88.1] | 60.8 [40.7-92.2] | 0.2575 |
Sex
| Male | 8 (29.6%) | 8 (33.3%) | 16 (31.4%) | 0.776 |
Female | 19 (70.4%) | 16 (66.7%) | 35 (68.6%) | ||
HIV
| No | 8 (88.9%) | 9 (100%) | 17 (94.4%) | 1 |
Yes | 1 (11.1%) | 1 (5.6%) | |||
WHO
| 0 | 13 (54.2%) | 18 (78.3%) | 31 (66%) | 0.233 |
1 | 8 (33.3%) | 4 (17.4%) | 12 (25.5%) | ||
2 | 3 (12.5%) | 1 (4.4%) | 4 (8.5%) | ||
T-stage
| T1/T2/Tis | 12 (44.4%) | 11 (47.8%) | 23 (46%) | |
T3/T4 | 15 (55.6%) | 12 (52.2%) | 27 (54%) | 0.811 | |
Tx | 0 | 1 (4.2%) | 1 (2%) | ||
N-stage
| N0 | 17 (65.4%) | 10 (41.7%) | 27 (54%) | 0.093 |
N1/N2/N3 | 9 (34.6%) | 14 (58.3%) | 23 (46%) | ||
Nx | 1 (3.7%) | 0 | 1 (2%) | ||
Histology
| Squamous cell | 23 (85.2%) | 22 (91.7%) | 45 (88.2%) | 0.671 |
Others | 4 (14.8%) | 2 (8.3%) | 6 (11.8%) |
Radiochemotherapy
Dosimetric analysis
Gap
Toxicity
Evaluation of the response and follow-up
Statistics
Results
Radiotherapy
Chemotherapy
Duration of treatment and interruptions
Toxicity
G1/G2 | G3/G4 | ||||||||
---|---|---|---|---|---|---|---|---|---|
3D-CRT n=27 | IMRT n=24 | Total n=51 | P value | 3D-CRT n=27 | IMRT n=24 | Total n=51 | P value | ||
Acute
|
Perineal skin
| 13 (48.1%) | 13 (54.2%) | 26 (51%) | 0.756 | 9 (33.3%) | 9 (37.5%) | 18 (35.3%) | 0.756 |
Diarrhea
| 12 (0.44%) | 11 (45.8%) | 23 (45.2%) | 1 | 1 (3.7%) | 1 (4.2%) | 2 (3.9%) | 1 | |
Pain
| 10 (37%) | 15 (62.5%) | 25 (49%) | 0.331 | 1 (3.7%) | 3 (12.5%) | 4 (7.8%) | 0.331 | |
Neutropenia
| 1 (0.04%) | 0 | 1 (2%) | 1 | 1 (3.7%) | 1 (4.2%) | 2 (3.9%) | 1 | |
Late
|
Rectal bleeding
| 6 (22.2%) | 6 (0.25%) | 12 (24.5%) | 1 | 1 (3.9%) | 0 | 1 | 1 |
Impotence
| 0 | 0 | 0 | 1 | 1 (12.5%) | 0 | 1 | 1 |
Clinical response
Follow-up and outcomes
Dosimetric comparison of 3D-CRT and IMRT
3D-CRT (n= 18) Mean value | IMRT (n= 20) Mean value | P value | |
---|---|---|---|
Total dose
| 58.3 Gy | 58.9 Gy | 0.366 |
Urinary bladder
| |||
D mean
| 44.8 Gy | 34.5 Gy | 0.008 |
Dmax
| 59.8 Gy | 55.4 Gy | 0.363 |
Dmin
| 32.5 Gy | 19.0 Gy | 0.034 |
D95
| 34.1 Gy | 22.8 Gy | 0.061 |
Right femoral
| |||
head Dmean
| 29.9 Gy | 26.9 Gy | 0.582 |
Left femoral head
| |||
Dmean
| 32.8 Gy | 27.1 Gy | 0.133 |
Small bowel
| |||
Dmean
| 13.4 Gy | 17.8% | 0.632 |
Dmax
| 47.8 Gy | 46.3% | 1 |
V30
| 16% | 22.7% | 0.719 |
V40
| 0% | 8.5% | 0.195 |
V50
| 0% | 2.9% | 0.273 |
V60
| 0% | 0.5% | 0.484 |
PTV1
| |||
Dmax
| 62.1 Gy | 62.3 Gy | 0.473 |
Dmin
| 26.6 Gy | 27.2 Gy | 0.702 |
Dmean
| 51.1 Gy | 50.3 Gy | 0.962 |
D95
| 37.2 Gy | 37.4 Gy | 0.702 |
PTV2
| |||
Dmax
| 62.2 Gy | 62.3 Gy | 0.426 |
Dmin
| 33.9 Gy | 44.8 Gy | 0.408 |
Dmean
| 59.9 Gy | 58.8 Gy | 0.655 |
D95
| 57.8 Gy | 57.6 Gy | 0.014 |
Predictive factors for local control, and overall and colostomy-free survival
Overall survival | Locoregional relapse-free survival | Colostomy-free survival | |||||||
---|---|---|---|---|---|---|---|---|---|
HR | CI 95% | p-value | HR | CI 95% | p-value | HR | CI 95% | p-value | |
WHO
| |||||||||
0
|
1
|
[0.99-7.17]
|
0.053
|
1
|
[0.83-5.64]
|
0.115
|
1
|
[1.3-8.07]
|
0.012
|
1/2
|
2.66
|
2.16
|
3.24
| ||||||
T Stage
| |||||||||
T1/T2/in situ
|
1
|
[0.45-3.42]
|
0.684
|
1
|
[0.38-2.64]
|
1
|
1
|
[0.44-2.73]
|
0.846
|
T3/T4
|
1.23
|
1
|
1.1
| ||||||
N Stage
| |||||||||
N0
|
1
|
[0.95-7.5]
|
0.062
|
1
|
[0.97-7.46]
|
0.057
|
1
|
[1.04-6.91]
|
0.042
|
N1/N2/N3
|
2.67
|
2.69
|
2.68
| ||||||
Histology
| |||||||||
Squamous cell cancer other
|
1 0.86
|
[0.2-3.82]
|
0.846
|
1 0.83
|
[0.19-3.65]
|
0.809
|
1 0.68
|
[0.16-2.97]
|
0.612
|
Treatment duration
| |||||||||
<56 days
|
1
|
[0.26-1.96]
|
0.511
|
1
|
[0.23-1.60]
|
0.317
|
1
|
[0.23-1.49]
|
0.262
|
>56 days
|
0.71
|
0.61
|
0.59
| ||||||
Total dose
| |||||||||
<50 Gy
|
1
|
[0.11-6.47]
|
0.874
|
1
|
[0.14-8.09]
|
0.951
|
1
|
[0.04-0.88]
|
0.033
|
>50 Gy
|
0.85
|
1.07
|
0.19
| ||||||
Technique
| |||||||||
3D-CRT
|
1
|
[0.46-3.94]
|
0.580
|
1
|
[0.55-3.98]
|
0.431
|
1
|
[0.81-5.66]
|
0.125
|
IMRT
|
1.35
|
1.48
|
2.14
| ||||||
Treatment breaks for toxicity
| |||||||||
Yes
|
1
|
[0.23-4.46]
|
0.996
|
1
|
[0.37-4.56]
|
0.680
|
1
|
[0.16-2.96]
|
0.607
|
No
|
1
|
1.3
|
0.68
| ||||||
Planned gap
| |||||||||
Yes
|
1
|
[0.29-3.17]
|
0.943
|
1
|
[0.3-2.4]
|
0.765
|
1
|
[0.37-3.17]
|
0.882
|
No
|
0.96
|
0.85
|
1.08
| ||||||
Pelvic radiotherapy
| |||||||||
Yes
|
1
|
[0.34-3.33]
|
0.905
|
1
|
[0.44-5.35]
|
0.501
|
1
|
[0.45-4.1]
|
0.587
|
No
|
1.07
|
1.54
|
1.36
|
Predictive factors for G3 or G4 acute toxicity
Discussion
Number of patients | Follow-up (months) | Locoregional control (%) | Treatment breaks (%) | Breaks (days) | Rates of grade 3+ GI toxicity (%) | Rates of grade 3+ skin toxicity (%) | Rate of grade 3 and 4 haematological toxicity (%) | Scale | |
---|---|---|---|---|---|---|---|---|---|
47 | Median 14 | 90 (2-y) | 18 (AT) | Median 5 (2-7) | 10 | 0 | 24 | CTC V3 | |
46 | Median | CTC V3 | |||||||
17 (3D) | 3D : 26 | 3D : 56.7 (3-y) | 3D : 88 (AT) | 3D : 12 | 3D : 29 | 3D : 41 | 3D : 29 | ||
29(IMRT | IMRT: 32 | IMRT : 91.9 (3-y) (P<0.01) | IMRT : 34.5 (90% AT, 10% NC) (P=0.001) | IMRT : 1.5 (P<0.0001) | IMRT: 7 | IMRT: 21 | IMRT : 21 | ||
53 | Median | 83.9 (1.5-y) | 41.5 | Median | 15 | 38 | 59 | CTC V3 | |
14.5 | (AT) | 4 (2-14) | |||||||
43 | 24 | 95 (2-y) | 40 | Median | 7 | 10 | 61 | CTC V3 | |
(AT+NC) 35 (toxicity) | 2 (2-24) | ||||||||
52 | 23.2 | 80 (2-y) | NR | NR | 22 | 20 | NR | CTC V3 | |
17 | 20.3 | 82 (2-y) | 24 (AT) | NR | 0 | 0 | 38 | RTOG | |
6 | 25 | 100 (3-y) | 50 | 1- 3 | 67 | 0 | CTC V3 | ||
Vautravers-Dewas
et al.
| 51 | Median | 17.6 | Median | 3D : 3.7 | 35.3 | 4 | CTC V3 | |
3D : 60 | 88 (2-y) | (AT) | 15 (1-43) | IMRT : 20.8 | |||||
IMRT : 23 | 65.8 (2-y) | (P=0.088) |