Session Item

Anal squamous cell carcinoma (ASCC) is a rare disease with increasing incidence. The radiotherapy dose and treatment volumes prescription varies considerably among the different treatment guidelines (NCCN, UK, French, ESMO). There are several international treatment guidelines available but there is rather large variety with regards to radiotherapy dose and technique.  We conducted a patterns of care survey to assess how patients are treated in German speaking countries.

An anonymous questionnaire containing 18 questions was created. The survey was sent to 361 German Society of Radiation Oncology (DEGRO)-associated institutions, including German-speaking radiation oncology departments of 41 universities, 118 non-university institutions and 202 radiation oncology private practice clinics.

Between 06/2019 and 09/2019, we received a total of 101 answers including 20 (19.8%) from university departments, 36 (35.6%) from non-university clinics and 45 (44.6%) from out-patient practices. 28 (27.8%) institutions treat more than 5 patients with early ASCC and 42 (41.6%) institutions treat more than 5 patients with locoregionally advanced ASCC per year. A minority of 18 (17.8%) of institutions use a FDG PET-CT for planning, whereas a majority of institutions want a MRI of the pelvis (86, 85%). Suspicious inguinal node biopsy was requested regularly by 12 (11.8%) institutions. Routine screening for infection with human immunodeficiency virus (HIV) is done in 28 (27.7%) institutions. IMRT or similar techniques are used by the majority of departments (97%). The prescribed doses to the elective lymph node CTV ranged considerably from 30.6 Gy to 52.8 Gy, whereas the dose range for the involved lymph node CTV ranged from 30.6 to 59.4 Gy, but 87% of institutions prescribed doses from 50.4 – 55. 8 Gy. The dose to gross disease of cT1 or cT2 ASCC ranged from 50 to more than 60 Gy and for cT3 or cT4 tumors the target dose ranged from 54 to more than 60 Gy. Brachytherapy as alternative to a percutaneous boost is used in 15 (14.8%) departments. The majority of departments use 5-FU/Mitomycin C as chemotherapy, whereas 6 (6%) departments prescribed Capecitabine/Mitomycin C. HIV positive patients are treated with standard CRT without dose reduction in 87 (86.1%) institutions, whereas 5 (4.9%) institutions use a reduced dose of chemotherapy and another 5 (4.9%) did not prescribe concurrent chemotherapy. Regarding the timepoint for assessing whether the patient had a clinical remission (CR) or residual disease, 2 (2%) institutions use 4-6 weeks after end of treatment, 20 (19.8%) use 6-8 weeks after end of treatment and 79 (78%) wait up to 5 months after end of treatment.

We observed several differences in radiotherapy doses, treatment technique and how HIV positive patients were treated among German-speaking radiation oncology institutions. These data further underline the need for an international consensus treatment guideline for ASCC.