Influence of IMRT-technologies on results of treatment of patients with squamous cell carcinoma of anal canal

Purpose. Chemoradiotherapy in the treatment of anal canal cancer leads to high local control rates, but is associated with significant early toxicity. This article presents the experience of using intensity modulated radiotherapy and its efficacy, and also frequency and severity of adverse side effects in patients with squamous cell carcinoma of the anal canal. Materials and Methods. Between years 2011 and 2015, 112 patients with morphologically confirmed squamous cell carcinoma of the anal canal received chemoradiotherapy using intensity modulated radiotherapy (IMRT); two different chemotherapy regimens were used: cisplatin/bleomycin or mitomycin C. In some patients, the irradiated volumes received a different daily dose of radiation, while maintaining the same number of fractions - the simultaneus integrated boost (SIB) method. Results: Staging of the tumor process was performed according to the TNM-system (7th edition): Stage I - 4 (3.6 %) patients, II - 39 (34.8 %). More than half of the patients had III-A and III-B stages - 33 (29.5 %) and 34 (30.3 %) respectively, and IV in 2 (1.8 %) patients. Median mean follow-up after the end of CRT in 112 patients was 32 months (the range of 7-60 months). The majority of patients were females (n = 94; 83.9 %), the median age was 56 years. The course of treatment without a break was conducted in 65 (58 %) patients. The use of IMRT technology in the SIB variant in comparison with the sequential decrease of the irradiated volume (from total volume including the tumor and lymph nodes up to residual tumor) showed a tendency to decrease the rates of locoregional recurrence: 2 (5.1 %) and 6 (14 %) patients respectively (p = 0.269). It was found that all relapses occurred in patients with advanced disease (III-A and III-B stages). The use of SIB caused a tendency to decrease the rate of distant metastases appearance: from 7 (16.3 %) to 3 (7.7 %) patients (p = 0.318). The combination of radiotherapy and mitomycin C promoted a significant increase in the stage II gastrointestinal toxicity in 33 (53.2%) patients (p = 0.021); haematologic toxicity in 37 (59,7%) patients (p = 0,001); and stage III dermatological toxicity was found in 20 (32,3 %) patients (p = 0,002). Conclusions. The use of improved IMRT-technologies has shown a tendency to reduce locoregional recurrence rate and distant metastases appearance and is an effective part of chemoradiation treatment of anal canal cancer.

squamous cell carcinoma of the anal canal, Intensity modulated radiation therapy (IMRT)

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