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Comparing simultaneous integrated boost vs sequential boost in anal cancer patients: results of a retrospective observational study

  • Franco, Pierfrancesco1
  • De Bari, Berardino2
  • Arcadipane, Francesca1
  • Lepinoy, Alexis3
  • Ceccarelli, Manuela4
  • Furfaro, Gabriella1
  • Mistrangelo, Massimiliano5
  • Cassoni, Paola6
  • Valgiusti, Martina7
  • Passardi, Alessandro7
  • Casadei Gardini, Andrea7
  • Trino, Elisabetta1
  • Martini, Stefania1
  • Iorio, Giuseppe Carlo1
  • Evangelista, Andrea4
  • Ricardi, Umberto1
  • Créhange, Gilles8
  • 1 University of Turin, Department of Oncology, Radiation Oncology, Via Genova 3, Turin, 10126, Italy , Turin (Italy)
  • 2 Centre Hospitalier Régional Universitaire ‘Jean Minjoz’, Department of Radiation Oncology, Besançon, France , Besançon (France)
  • 3 Centre ‘Paul Strauss’, Department of Radiation Oncology, Strasbourg, France , Strasbourg (France)
  • 4 Unit of Cancer Epidemiology and CPO Piedmont, AOU Citta’ della Salute e della Scienza, Turin, Italy , Turin (Italy)
  • 5 University of Turin, Department of Surgical Sciences, Turin, Italy , Turin (Italy)
  • 6 University of Turin, Department of Medical Sciences, Pathology Unit, Turin, Italy , Turin (Italy)
  • 7 Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Department of Medical Oncology, Meldola, Italy , Meldola (Italy)
  • 8 Centre ‘Georges-François-Leclerc’, Department of Radiation Oncology, Dijon, France , Dijon (France)
Published Article
Radiation Oncology
Springer (Biomed Central Ltd.)
Publication Date
Sep 10, 2018
DOI: 10.1186/s13014-018-1124-9
Springer Nature


BackgroundTo evaluate clinical outcomes of simultaneous integrated boost (SIB) - intensity modulated radiotherapy (RT) in patients with non metastatic anal cancer compared to those of a set of patients treated with 3-dimensional conformal RT and sequential boost (SeqB).MethodsA retrospective cohort of 190 anal cancer patients treated at 3 academic centers with concurrent chemo-RT employing either SIB or SeqB was analysed. The SIB-group consisted of 87 patients, treated with 2 cycles of Mitomycin (MMC) and 5-Fluorouracil (5FU) using SIB-IMRT delivering 42-45Gy/28–30 fractions to the elective pelvic lymph nodes and 50.4-54Gy/28-30fractions to the primary tumor and involved nodes, based on pre-treatment staging. The SeqB group comprised 103 patients, treated with MMC associated to either 5FU or Capecitabine concurrent to RT with 36 Gy/20 fractions to a single volume including gross tumor, clinical nodes and elective nodal volumes and a SeqB to primary tumor and involved nodes of 23.4 Gy/13 fractions. We compared colostomy-free survival (CFS), overall survival (OS) and the cumulative incidence of colostomy for each radiation modality. Cox proportional-hazards model addressed factors influencing OS and CFS.ResultsMedian follow up was 34 (range 9–102) and 31 months (range 2–101) in the SIB and SeqB groups. The 1- and 2-year cumulative incidences of colostomy were 8.2% (95%CI:3.6–15.2) and 15.0% (95%CI:8.1–23.9) in the SIB group and 13.9% (95%CI: 7.8–21.8) and 18.1% (95%CI:10.8–27.0) in the SeqB group. Two-year CFS and OS were 78.1% (95%CI:67.0–85.8) and 87.5% (95%CI:77.3–93.3) in the SIB group and 73.5% (95%CI:62.6–81.7) and 85.4% (95%CI:75.5–91.6) in the SeqB, respectively. A Cox proportional hazards regression model highlighted an adjusted hazard ratio (AdjHR) of 1.18 (95%CI: 0.67–2.09;p = 0.560), although AdjHR for the first 24 months was 0.95 (95%CI: 0.49–1.84;p = 0.877) for the SIB approach.ConclusionsSIB-based RT provides similar clinical outcomes compared to SeqB-based in the treatment of patients affected with non metastatic anal cancer.

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