Intensity-Modulated Radiotherapy (IMRT) vs Helical Tomotherapy (HT) in Concurrent Chemoradiotherapy (CRT) for Patients with Anal Canal Carcinoma (ACC): an analysis of dose distribution and toxicities

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dc.contributor.authorYeung, Rosanna
dc.contributor.authorMcConnell, Yarrow
dc.contributor.authorWarkentin, Heather
dc.contributor.authorGraham, Darren
dc.contributor.authorWarkentin, Brad
dc.contributor.authorJoseph, Kurian
dc.contributor.authorDoll, Corinne M
dc.date.accessioned2015-07-30T18:21:01Z
dc.date.available2015-07-30T18:21:01Z
dc.date.issued2015-04-17
dc.description.abstractPurpose Intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) have been adopted for radiotherapy treatment of anal canal carcinoma (ACC) due to better conformality, dose homogeneity and normal-tissue sparing compared to 3D-CRT. To date, only one published study compares dosimetric parameters of IMRT vs HT in ACC, but there are no published data comparing toxicities. Our objectives were to compare dosimetry and toxicities between these modalities. Methods and materials This is a retrospective study of 35 ACC patients treated with radical chemoradiotherapy at two tertiary cancer institutions from 2008–2010. The use of IMRT vs HT was primarily based on center availability. The majority of patients received fluorouracil (5-FU) and 1–2 cycles of mitomycin C (MMC); 2 received 5-FU and cisplatin. Primary tumor and elective nodes were prescribed to ≥54Gy and ≥45Gy, respectively. Patients were grouped into two cohorts: IMRT vs HT. The primary endpoint was a dosimetric comparison between the cohorts; the secondary endpoint was comparison of toxicities. Results 18 patients were treated with IMRT and 17 with HT. Most IMRT patients received 5-FU and 1 MMC cycle, while most HT patients received 2 MMC cycles (p < 0.01), based on center policy. HT achieved more homogenous coverage of the primary tumor (HT homogeneity and uniformity index 0.14 and 1.02 vs 0.29 and 1.06 for IMRT, p = 0.01 and p < 0.01). Elective nodal coverage did not differ. IMRT achieved better bladder, femoral head and peritoneal space sparing (V30 and V40, p ≤ 0.01), and lower mean skin dose (p < 0.01). HT delivered lower bone marrow (V10, p < 0.01) and external genitalia dose (V20 and V30, p < 0.01). Grade 2+ hematological and non-hematological toxicities were similar. Febrile neutropenia and unscheduled treatment breaks did not differ (both p = 0.13), nor did 3-year overall and disease-free survival (p = 0.13, p = 0.68). Conclusions Chemoradiotherapy treatment of ACC using IMRT vs HT results in differences in dose homogenity and normal-tissue sparing, but no significant differences in toxicities.en_US
dc.description.refereedYesen_US
dc.description.sponsorshipSponsored by the University of Calgary Open Access Author’s Fund.en_US
dc.identifier.citationYeung, R., McConnell, Y., Warkentin, H., Graham, D., Warkentin, B., Joseph, K., & Doll, C. M. (2015). Intensity-Modulated Radiotherapy (IMRT) vs Helical Tomotherapy (HT) in Concurrent Chemoradiotherapy (CRT) for Patients with Anal Canal Carcinoma (ACC): an analysis of dose distribution and toxicities. Radiation Oncology, 10(1), 92.en_US
dc.identifier.doi10.1186/s13014-015-0398-4
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/33520
dc.identifier.urihttp://hdl.handle.net/1880/50722
dc.language.isoenen_US
dc.publisherRadiation Oncologyen_US
dc.publisher.departmentOncologyen_US
dc.publisher.facultyCumming School of Medicineen_US
dc.publisher.institutionUniversity of Calgaryen_US
dc.publisher.urlhttp://www.ro-journal.com/content/10/1/92en_US
dc.rightsAttribution 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectAnal canceren_US
dc.subjectTomotherapyen_US
dc.subjectIntensity modulated radiotherapyen_US
dc.subjectDosimetryen_US
dc.subjectToxicitiesen_US
dc.titleIntensity-Modulated Radiotherapy (IMRT) vs Helical Tomotherapy (HT) in Concurrent Chemoradiotherapy (CRT) for Patients with Anal Canal Carcinoma (ACC): an analysis of dose distribution and toxicitiesen_US
dc.typejournal article
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