Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Can we omit prophylactic inguinal nodal irradiation in anal cancer patients?

  • Kim, Hakyoung (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Hee Chul (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yu, Jeong Il (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Doo Ho (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ahn, Yong Chan (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Seung Tae (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Joon Oh (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Young Suk (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hee Cheol (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2015.03.09
  • Accepted : 2015.05.14
  • Published : 2015.06.30
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Abstract

Purpose: To evaluate the appropriateness of prophylactic inguinal nodal irradiation (PINI), we analyzed patterns of failure in anal cancer patients who were inguinal node-negative at presentation and did not receive PINI. Materials and Methods: We retrospectively reviewed the records of 33 anal cancer patients treated by definitive concurrent chemoradiation therapy (CCRT) between 1994 and 2013. Radiotherapy consisted of a total dose of 44-45 Gy (22-25 fractions in 5 weeks) on the whole pelvis, anus, and perineum. Except inguinal lymphadenopathy was present at initial diagnosis, the entire inguinal chain was not included in the radiation field. In other words, there was no PINI. Results: The median follow-up duration was 50 months (range, 4 to 218 months). Median survival and progression-free survival (PFS) were 57 months (range, 10 to 218 months) and 50 months (range, 4 to 218 months), respectively. Among the survival, the median follow-up duration was 51 months (range, 12 to 218 months). The 5-year overall survival and PFS rates were 93.4% and 88.8%, respectively. Although none of the patients received inguinal node irradiation for prophylactic purposes, there was no inguinal recurrence. Conclusion: Treatment of anal cancer by omitting PINI might be considered in selected patients with clinically uninvolved inguinal nodes.

Keywords

References

  1. Whiteford MH, Stevens KR Jr, Oh S, Deveney KE. The evolving treatment of anal cancer: how are we doing? Arch Surg 2001;136:886-91. https://doi.org/10.1001/archsurg.136.8.886
  2. Ryan DP, Compton CC, Mayer RJ. Carcinoma of the anal canal. N Engl J Med 2000;342:792-800. https://doi.org/10.1056/NEJM200003163421107
  3. Recio PM. Radical surgery in the treatment of epidermoid carcinoma of the anal canal. Philipp J Surg 1955;10:1-8.
  4. Harrison EG Jr, Beahrs OH, Hill JR. Anal and perianal malignant neoplasms: pathology and treatment. Dis Colon Rectum 1966;9:255-67. https://doi.org/10.1007/BF02616920
  5. Nigro ND, Vaitkevicius VK, Considine B Jr. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 1974;17:354-6. https://doi.org/10.1007/BF02586980
  6. Cummings BJ, Keane TJ, O'Sullivan B, Wong CS, Catton CN. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C. Int J Radiat Oncol Biol Phys 1991;21:1115-25. https://doi.org/10.1016/0360-3016(91)90265-6
  7. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 1996;348:1049-54. https://doi.org/10.1016/S0140-6736(96)03409-5
  8. Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 1996;14:2527-39. https://doi.org/10.1200/JCO.1996.14.9.2527
  9. Bartelink H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 1997;15:2040-9. https://doi.org/10.1200/JCO.1997.15.5.2040
  10. Chie EK, Ha SW, Park JG, Bang YJ, Heo DS, Kim NK. Treatment results in anal cancer: non-operative treatment versus operative treatment. J Korean Soc Ther Radiol Oncol 2002;20:62-7.
  11. Lee WS, Chun HK, Lee WY, et al. Anal canal carcinoma: experience from a single Korean institution. Yonsei Med J 2007;48:827-32. https://doi.org/10.3349/ymj.2007.48.5.827
  12. Ajani JA, Winter KA, Gunderson LL, et al. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA 2008;299:1914-21. https://doi.org/10.1001/jama.299.16.1914
  13. James RD, Glynne-Jones R, Meadows HM, et al. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, $2{\times}2$ factorial trial. Lancet Oncol 2013;14:516-24. https://doi.org/10.1016/S1470-2045(13)70086-X
  14. Ortholan C, Resbeut M, Hannoun-Levi JM, et al. Anal canal cancer: management of inguinal nodes and benefit of prophylactic inguinal irradiation (CORS-03 Study). Int J Radiat Oncol Biol Phys 2012;82:1988-95. https://doi.org/10.1016/j.ijrobp.2011.02.010
  15. Crowley C, Winship AZ, Hawkins MA, Morris SL, Leslie MD. Size does matter: can we reduce the radiotherapy field size for selected cases of anal canal cancer undergoing chemoradiation? Clin Oncol (R Coll Radiol) 2009;21:376-9. https://doi.org/10.1016/j.clon.2009.01.015
  16. Kachnic LA, Winter K, Myerson RJ, et al. RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys 2013;86:27-33. https://doi.org/10.1016/j.ijrobp.2012.09.023
  17. Peiffert D, Tournier-Rangeard L, Gerard JP, et al. Induction chemotherapy and dose intensification of the radiation boost in locally advanced anal canal carcinoma: final analysis of the randomized UNICANCER ACCORD 03 trial. J Clin Oncol 2012;30:1941-8. https://doi.org/10.1200/JCO.2011.35.4837
  18. Gerard JP, Chapet O, Samiei F, et al. Management of inguinal lymph node metastases in patients with carcinoma of the anal canal: experience in a series of 270 patients treated in Lyon and review of the literature. Cancer 2001;92:77-84. https://doi.org/10.1002/1097-0142(20010701)92:1<77::AID-CNCR1294>3.0.CO;2-P
  19. Das P, Bhatia S, Eng C, et al. Predictors and patterns of recurrence after definitive chemoradiation for anal cancer. Int J Radiat Oncol Biol Phys 2007;68:794-800. https://doi.org/10.1016/j.ijrobp.2006.12.052
  20. Cotter SE, Grigsby PW, Siegel BA, et al. FDG-PET/CT in the evaluation of anal carcinoma. Int J Radiat Oncol Biol Phys 2006;65:720-5. https://doi.org/10.1016/j.ijrobp.2006.01.009
  21. Nguyen BT, Joon DL, Khoo V, et al. Assessing the impact of FDG-PET in the management of anal cancer. Radiother Oncol 2008;87:376-82. https://doi.org/10.1016/j.radonc.2008.04.003
  22. Mai SK, Welzel G, Hermann B, Wenz F, Haberkorn U, Dinter DJ. Can the radiation dose to CT-enlarged but FDG-PET-negative inguinal lymph nodes in anal cancer be reduced? Strahlenther Onkol 2009;185:254-9. https://doi.org/10.1007/s00066-009-1944-5
  23. Mistrangelo M, Pelosi E, Bello M, et al. Comparison of positron emission tomography scanning and sentinel node biopsy in the detection of inguinal node metastases in patients with anal cancer. Int J Radiat Oncol Biol Phys 2010;77:73-8. https://doi.org/10.1016/j.ijrobp.2009.04.020

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