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Clinical track: Lower GI (colon, rectum, anus)
9306
Poster
Clinical
00:00 - 00:00
Intensified IMRT-SIB and capecitabine-based chemotherapy in anal cancer:an institutional experience
PO-1113

Abstract

Intensified IMRT-SIB and capecitabine-based chemotherapy in anal cancer:an institutional experience
Authors: Palazzari|, Elisa(1)*[elipala83@gmail.com];Schioppa |, Ornella(2);Lauretta|, Andrea(3);Navarria |, Federico(1);Gigante|, Marco(1);Caroli|, Angela(1);Bampo|, Chiara(4);Innocente|, Roberto(1);Polesel |, Jerry(5);Bertola|, Giulio(3);Vaccher|, Emanuela(2);De Paoli|, Antonino(1);
(1)CRO IRCCS Aviano National Cancer Institute, Radiation Oncology Dep, Aviano PN, Italy;(2)CRO IRCCS Aviano National Cancer Institute, Medical Oncology Dep, Aviano PN, Italy;(3)CRO IRCCS Aviano National Cancer Institute, Surgical Oncology Dep, Aviano PN, Italy;(4)CRO IRCCS Aviano National Cancer Institute, Nuclear Medicine Dep, Aviano PN, Italy;(5)CRO IRCCS Aviano National Cancer Institute, Cancer Epidemiolgy Unit, Aviano PN, Italy;
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Purpose or Objective

To assess acute and late toxicity, and efficacy of intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) and concurrent capecitabine-based chemotherapy in an HIV negative (HIV-) and HIV positive (HIV+)  anal cancer (AC) patient population.

 

Material and Methods

We retrospectively analyzed the records of patients (pts) with histologically confirmed AC treated with IMRT 45 Gy/25 fractions on low-risk volume and SIB on intermediate risk (positive nodes<3cm) and  high risk volume (Tumor and positive nosed>3cm). Concomitant chemotherapy was Capecitabine given orally (650 mg/m2 twice daily) seven days a week with either Mitomycin-C (10 mg/m2) on day 1 or weekly Carboplatin (AUC2). Acute and late toxicities were evaluated according to the CTC-AE 4.0 scale. Disease evaluation after chemo-radiotherapy (CRT) was performed by MRI, PET , CT scan and endoscopy. Efficacy was evaluated in terms of clinical response (CR) at 8 and 24 weeks from CRT, local control, colostomy free survival (CFS), PFS and OS.

Results

From January 2011 and June 2018, 51 pts were included. Median age was 60 years (range 41-85). Eight pts (16%) were HIV+ in cART. All pts had normal sphincter function before treatment. Forty-six (90%) pts had squamous and 5 (10) adenocarcinoma AC. Thirty-four pts (66%) had stage III disease, 8 (16%) stage II, 3 (7%) stage I and 6 (11%) stage IV (paraortic lymph nodes involvement), respectively. All 51 pts, including HIV+, received Capecitabine at plenned dose, 44 pts (86%) received Mitomycin-C and 7 (14%) Carboplatin. Median SIB dose to high risk volume was 54 Gy (range 52.5-55) in 25 fractions. Median SIB dose intermediate risk volume was 52.5 Gy (range 52.5-54). Fifty pts (98%) completed the planned IMRT-SIB. Grade 3 hematologic or gastrointestinal toxicity was reported in 4 (7.8%)  pts , and grade 3 dermatitis in 20 (39%). A break in CRT was needed in 10 pts (19.6%) because of toxicity. Grade 3 toxicity was reported in 4 (50%) HIV+ pts. Late grade 2 proctitis occurred  in 3 pt (6%), no grade 3 late toxicity was reported. After 8 weeks from CRT 50/51 pts were evaluated for response, 34 of them (68%) showed a clinical complete response (cCR) and 15 (30%) a partial response (cPR). After 24 weeks, 47 pts were evaluable, 37 of them (80%) had a cCR, 8 cPR and 2 progressive disease. Surgical salvage was performed in 6 pts with cPR. With a median follow up of 32 months, 2 years (yrs) LC,CFS, PFS and OS were 90%, 85%, 88% and 92% respectively. Five yrs LC, CFS, PFS and OS were 84%, 78%, 57% and 62% respectively. HIV+ pts showe the same LC and survival.

Conclusion

IMRT-SIB and concurrent Capecitabine plus Mitomycin-C or Carboplatin chemotherapy appears feasible and safe in AC pts. Also HIV+ pts can safely receive this intensified treatment. LC, CFS, PFS and OS results are well comparable with the available data of current standard treatment.