eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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3/2021
vol. 13
 
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abstract:
Original paper

Pulse-dose-rate interstitial brachytherapy in anal squamous cell carcinoma: clinical outcomes and patients’ health quality perception

Rémi Bourdais
1
,
Samir Achkar
1
,
Sophie Espenel
1
,
Sophie Bockel
1
,
Laetitia Chauffert-Yvart
2
,
Florence Ravet de Mellis
1
,
Minh-Hanh Ta
1
,
Wassila Boukhelif
3
,
Jérôme Durand-Labrunie
1
,
Pascal Burtin
1
,
Christine Haie-Meder
1
,
Eric Deutsch
1, 4
,
Cyrus Chargari
1, 4, 5

1.
Brachytherapy Unit, Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
2.
Medical Oncology Department, Henri Mondor Hospital, AP-HP, Creteil, France
3.
Radiation Oncology Department, Centre Hospitalier Intercommunal, Creteil, France
4.
INSERM1030 Radiothérapie Moléculaire et Innovations Thérapeutiques, Université Paris-Saclay, Villejuif, France
5.
French Military Health Academy, Ecole du Val-de-Grâce, Paris, France
J Contemp Brachytherapy 2021; 13, 3: 263–272
Online publish date: 2021/05/18
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Introduction
To examine clinical outcomes and quality of life of patients with anal squamous cell carcinoma treated with interstitial pulsed-dose-rate brachytherapy (PDR-BT) with a boost to residual tumor after external radiotherapy.

Material and methods
Medical records of patients receiving a brachytherapy boost after radiotherapy for anal squamous cell carcinoma in our Institute between 2008 and 2019 were retrospectively reviewed. After receiving pelvic irradiation ± concurrent chemotherapy, patients received PDR-BT boost to residual tumor, in order to deliver a minimal total dose of 60 Gy. Patients’ outcomes were analyzed, with primary focus on local control, sphincter preservation, morbidity, and quality of life.

Results
A total of 42 patients were identified, included 24, 13, and 5 patients with I, II, and III tumor stages, respectively. Median brachytherapy (BT) dose was 20 Gy (range, 10-30 Gy). Median dose per pulse was 42 cGy (range, 37.5-50 cGy). With median follow-up of 60.4 months (range, 5.4-127.4 months), estimated local control and colostomy-free survival rates at 5 years were both 88.7% (95% CI: 67.4-96.4%). The largest axis of residual lesion after external beam radiation therapy (EBRT) and poor tumor shrinkage were associated with more frequent relapses (p = 0.02 and p = 0.007, respectively). Out of 40 patients with more than 6 months follow-up, only one experienced severe delayed toxicity (fecal incontinence). Health quality perception was very good or good in 20 of 22 (91%) patients, according to their replies of quality-of-life surveys. A total dose ≥ 63 Gy was associated with higher number of anorectal grade 1+ toxicities (n = 1.5 vs. n = 0.61, p = 0.02).

Conclusions
In this cohort of 42 patients with mainly I and II tumor stages, PDR-BT boost allowed for local control in 88.7% of patients, with only one grade 3 anorectal toxicity.

keywords:

anal squamous cell carcinoma, brachytherapy, pulsed-dose-rate, local control

 
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