Can Patients With Recurrent or Primary Squamous Cell Carcinoma of the Anus in a Previously Irradiated Pelvis Receive Definitive Reirradiation?

Rákkutatás · Anal squamous cell carcinoma

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.

Bizonyítékszint: Korai humán adat. Kis vagy feltáró emberi adat.

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