Predictors of acute toxicities during definitive chemoradiation using intensity-modulated radiotherapy for anal squamous cell carcinoma Journal Article


Authors: Julie, D. A. R.; Oh, J. H.; Apte, A. P.; Deasy, J. O.; Tom, A.; Wu, A. J.; Goodman, K. A.
Article Title: Predictors of acute toxicities during definitive chemoradiation using intensity-modulated radiotherapy for anal squamous cell carcinoma
Abstract: Purpose. To identify clinical and dosimetric factors associated with acute hematologic and gastrointestinal (GI) toxicities during definitive therapy using intensity-modulated radiotherapy (IMRT) for anal squamous cell carcinoma (ASCC). Materials and methods. We retrospectively analyzed 108 ASCC patients treated with IMRT. Clinical information included age, gender, stage, concurrent chemotherapy, mitomycin (MMC) chemotherapy and weekly hematologic and GI toxicity during IMRT. From contours of the bony pelvis and bowel, dose-volume parameters were extracted. Logistic regression models were used to test associations between toxicities and clinical or dosimetric predictors. Results. The median age was 59 years, 81 patients were women and 84 patients received concurrent MMC and 5-fluorouracil (5FU). On multivariate analysis (MVA), the model most predictive of Grade 2 + anemia included the maximum bony pelvis dose (Dmax), female gender, and T stage [p = 0.035, cross validation area under the curve (cvAUC) = 0.66]. The strongest model of Grade 2 + leukopenia included V10 (percentage of pelvic bone volume receiving ≥ 10 Gy) and number of MMC cycles (p = 0.276, cvAUC = 0.57). The model including MMC cycle number and T stage correlated best with Grade 2 + neutropenia (p = 0.306, cvAUC = 0.57). The model predictive of combined Grade 2 + hematologic toxicity (HT) included V10 and T stage (p = 0.016, cvAUC = 0.66). A model including VA45 (absolute bowel volume receiving ≥ 45 Gy) and MOH5 (mean dose to hottest 5% of bowel volume) best predicted diarrhea (p = 0.517, cvAUC = 0.56). Conclusion. Dosimetric constraints to the pelvic bones should be integrated into IMRT planning to reduce toxicity, potentially reducing treatment interruptions and improving disease outcomes in ASCC. Specifically, our results indicate that Dmax should be confined to ≤ 57 Gy to minimize anemia and that V10 should be restricted to ≤ 87% to reduce incidence of all HT. © 2015 Informa Healthcare.
Keywords: adult; treatment outcome; aged; major clinical study; neutropenia; intensity modulated radiation therapy; squamous cell carcinoma; fluorouracil; cancer combination chemotherapy; diarrhea; monotherapy; capecitabine; radiation dose; anemia; blood toxicity; gastrointestinal symptom; leukopenia; retrospective study; prediction; patient compliance; multivariate analysis; acute toxicity; mitomycin; logistic regression analysis; chemoradiotherapy; anus carcinoma; proctitis; human; male; female; priority journal; article; anus squamous cell carcinoma
Journal Title: Acta Oncologica
Volume: 55
Issue: 2
ISSN: 0284-186X
Publisher: Informa Healthcare  
Date Published: 2016-01-01
Start Page: 208
End Page: 216
Language: English
DOI: 10.3109/0284186x.2015.1043396
PROVIDER: scopus
PUBMED: 25984929
PMCID: PMC4822488
DOI/URL:
Notes: Article -- Export Date: 4 April 2016 -- Source: Scopus
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MSK Authors
  1. Karyn A Goodman
    245 Goodman
  2. Abraham Jing-Ching Wu
    202 Wu
  3. Jung Hun Oh
    114 Oh
  4. Joseph Owen Deasy
    279 Deasy
  5. Aditya Apte
    117 Apte
  6. Ashlyn Tom
    13 Tom