Radiotherapy with Intensity-Modulated (IMRT) Techniques in the Treatment of Anal Carcinoma (RAINSTORM): A Multicenter Study on Behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology) Gastrointestinal Study Group
L. Caravatta, Giovanna Mantello, Francesca Valvo, Pierfrancesco Franco, L. Gasparini, Consuelo Rosa, N. Slim, S. Manfrida, Francesca De Felice, Marianna Alessandra Gerardi, Stefano Vagge, Marco Krengli, Elisa Palazzari, Mattia Falchetto Osti, Alessandra Gonnelli, Gianpiero Catalano, P. Pittoni, Gilles Ivaldi, Alessandra Galardi, Marco Lupattelli, Maria Elena Rosetto, R.M. Niespolo, A. Guido, Oreste Durante, Gabriella Macchia, Fernando Muñoz, Badr El Khouzai, Maria Rosaria Lucido, Annamaria Porreca, Marta Di Nicola, Maria Antonietta Gambacorta, Vittorio Donato, Domenico Genovesi
Abstract
A multi-institutional retrospective study was conducted to evaluate the pattern of care and clinical outcomes of anal cancer patients treated with intensity-modulated radiotherapy (IMRT) techniques. In a cohort of 987 patients, the clinical complete response (CR) rate (beyond 6 months) was 90.6%. The 3-year local control (LC) rate was 85.8% (95% CI: 84.4–87.2), and the 3-year colostomy-free survival (CFS) rate was 77.9% (95% CI: 76.1–79.8). Three-year progression-free survival (PFS) and overall survival (OS) rates were 80.2% and 88.1% (95% CI: 78.8–89.4) (95% CI: 78.5–81.9), respectively. Histological grade 3 and nodal involvement were associated with lower CR (p = 0.030 and p = 0.004, respectively). A statistically significant association was found between advanced stage and nodal involvement, and LC, CFS, PFS, OS and event-free survival (EFS). Overall treatment time (OTT) ≥45 days showed a trend for a lower PFS (p = 0.050) and was significantly associated with lower EFS (p = 0.030) and histological grade 3 with a lower LC (p = 0.025). No statistically significant association was found between total dose, dose/fraction and/or boost modality and clinical outcomes. This analysis reports excellent clinical results and a mild toxicity profile, confirming IMRT techniques as standard of care for the curative treatment of anal cancer patients. Lymph node involvement and histological grade have been confirmed as the most important negative prognostic factors.