Journal of Contemporary Brachytherapy
eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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abstract:
Original paper

Chemoradiotherapy for anal canal cancers: Does the choice of boost technique matter?

Leonel Varela Cagetti
1
,
Julia Gilhodes
2
,
Marjorie Ferré
3
,
Marguerite Tyran
1
,
Morgan Guenole
1
,
Jean Philippe Ratone
4
,
Fabrice Caillol
4
,
Flora Poizat
5
,
Bernard Lelong
6
,
Cecile De Chaisemartin
6
,
Hélène Meillat
6
,
Christelle De la Fouchardière
7
,
Naji Salem
1
,
Agnès Tallet
1

  1. Department of Radiation Oncology, Institut Paoli-Calmettes, Marseille, France
  2. Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille Université, INSERM, IRD, SESSTIM, Marseille, France
  3. Department of Medical Physics, Institut Paoli-Calmettes, Marseille, France
  4. Oncology and Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France
  5. Department of Pathology, Institut Paoli-Calmettes, Marseille, France
  6. Department of Digestive Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
  7. Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
J Contemp Brachytherapy 2026
DOI: https://doi.org/10.5114/jcb.2026.160422
Online publish date: 2026/03/27
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Purpose
To analyze and compare the clinical outcomes of boost modality choice after external beam radiation therapy (EBRT) or chemoradiotherapy (CRT) for anal canal cancers (ACC).

Material and methods
162 patients with ACC were treated in our institution with two different boost modalities: EBRT boost (EBRTb) or high-dose-rate (HDR) interstitial brachytherapy boost (ISBT). Local relapse-free survival (LRFS), disease-free survival (DFS), overall survival (OS), colostomy-free survival (CFS), and toxicity rates were analyzed.

Results
With a median follow-up (FU) of 66 months, thirteen (8%) local recurrences were reported, six in the ISBT and seven in the EBRTb groups. The 5-year LRFS rate for the entire cohort was 87% (80-92%), without differences in both groups: 88% in ISBT vs. 86% in EBRTb group (p = 0.7). The 5-year DFS, OS, and CFS rates for the overall population were 84% (78-89%), 93% (88-96%), and 92% (88-95%), respectively, without significant differences between ISBT and EBRTb groups. Multivariate analysis for gastrointestinal (GI) toxicity found a non-significant tendency between EBRTb and GI toxicity grade ≥ 2: odds ratio (OR) = 1.82 (0.88-3.78), p = 0.1060. Univariate analysis for fecal incontinence revealed that EBRTb was significantly associated with fecal incontinence grade ≥ 2 (p = 0.0005), and this tendency was confirmed in the multivariate analysis (p = 0.0012). Sensitivity analysis, excluding patients with theoretical brachytherapy contraindications, confirmed these results. Univariate and multivariate assessments found ISBT as an independent prognosis factor for better sphincter function: OR = 5.44 (1.57-18.91), p = 0.0077.

Conclusions
CRT provide excellent rates of tumor control and colostomy-free survival. Compared with EBRTb, interstitial brachytherapy boost demonstrates a favorable profile in GI toxicity, with a low impact on fecal incontinence.

keywords:

anal canal cancer, brachytherapy, boost, chemoradiation, colostomy-free survival, high-dose-rate, fecal incontinence, quality of life, local relapse-free survival, local control

  
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