Can Patients With Recurrent or Primary Squamous Cell Carcinoma of the Anus in a Previously Irradiated Pelvis Receive Definitive Reirradiation?
Hyperfractionated accelerated reirradiation offers promising complete clinical response rates and durable pelvic control for patients with recurrent or new squamous cell carcinoma of the anus in a previously irradiated pelvis.
Purpose: Although salvage surgery is the standard of care for locoregionally recurrent anal cancer, few local options exist for inoperable pelvic recurrences. Newly diagnosed anal cancer arising in a previously irradiated field also provides a unique treatment challenge, as delivery of standard doses would result in unsafe cumulative dose to pelvic structures. We aimed to evaluate efficacy and toxicity of a hyperfractionated accelerated reirradiation (reRT) regimen for such patients. Methods and Materials: Patients treated with hyperfractionated accelerated reRT at a single institution between 2005 and 2024 for nonmetastatic inoperable locoregionally recurrent anal cancer or primary anal cancer in a previously irradiated field were included. The reRT regimen consisted of 1.5 Gy in twice daily fractions separated by 6 hours to a median (range) of 39 (30‑51) Gy. Complete clinical response rates, recurrence rates, and toxicities were reported. Results: The median follow‑up was 13.4 months. Complete clinical response rates were 46.2% for recurrent anal cancer and 77.8% for new primary SCCA after prior pelvic radiation. Two‑year locoregional recurrence was 64.0% among recurrent cases and 22.0% among primary cases. Grade 3 acute toxicity was observed in 22.9% of patients and grade 3‑4 late toxicity in 28.6%. Conclusions: Hyperfractionated accelerated reRT shows promising complete clinical response rates that appear to translate into durable pelvic control for patients with recurrent anal cancer or a new SCCA primary after prior pelvic radiation, with acceptable toxicity profiles.
Reirradiation provides a potentially curative, non‑surgical treatment option for patients with locoregional anal squamous cell carcinoma who have either recurrent disease or a new primary within a previously irradiated pelvis, addressing a critical unmet need in this patient population and potentially improving disease control while maintaining tolerable toxicity.
Evidence level: Korai humán adat. Kis vagy feltáró emberi adat.
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