947 / 1068
Improving IMRT in anal cancer: skin tox
- Reducing skin toxicity ? (Joseph 2015)
Study
Ajani et al. [
2
] -
RTOG 9811
Milano et al.
[
12
]
Salama et al.
[
13
]
Kachnic et al.
[
9
] -RTOG 0529
Han et al. [
8
] Current study
No. of patients
324
13
53
52
58
57
RT technique
3D-CRT
IMRT
IMRT
DP-IMRT
IMRT
HT
Target
Phase1: pelvis, perineum,
inguinal nodes, anus sup border at
L5/S1& inf border 2.5cm below
anus
Phase2: sup border reduced to
bottom of SI joint
Phase3 Boost: Tumor/Node +2-
2.5cm
Phase1: pelvic field: GTV
+ all regional nodes, sup
border 1cm below L5-S1
Phase2 boost:
GTV +1cm
CTV: GTV and areas at
risk (nodal region) +1cm
PTV: CTV +1cm
CTV
T
: GTV +2.5cm
CTV
N
: GTV +1cm
PTV: CTV +1cm
CTV
T
: GTV +1.5cm sup/inf &
1cm radially
PTV
T
: CTV +7mm
CTV
N0
: Vessel +1.5-2cm;
CTV
N+
: Node +1cm
PTV: CTV +7mm
CTV
T
/N+ve: GTV +1-
1.5cm
PTV
T
: CTV
T
/N+ve +1cm
CTV
N0
: Vessel +7mm
PTV
N
: CTV
N0
+1cm
Dose
Phase1: 30.6Gy/17fr
Phase2: 14.4Gy/8fr
Phase3 boost: 10-14Gy/5-7fr
Phase1: 45Gy/25fr
Phase2: 9Gy/5fr
Phase1: 45Gy/25fr
Phase2: 9Gy/5fr
T2N0: 42Gy to PTV
N0
&
50.4Gy to PTV
T
/28fractions
T3-4N0-3: 45Gy to PTV
N0
;
50.4Gy to PTV
N
<3cm &
54Gy to PTV
N
>3cm; 54Gy to
PTV
T
T1: 45Gy/25fr
T2 (2.1-4cm): 54Gy/30fr
T2-4(>4cm): 63Gy/35fr
N0: 27Gy/15fr
N+ve: 58.5-63Gy/35fr
PTV
T
: 54Gy/30fr
PTV
N0
: 45Gy/30fr
Percent of patients with acute toxicity scores (%)
Gastrointestinal
Grade 2
Grade
≥
3
38%
35%
69%
0%
57%
15%
52%
21%
59%
9%
53%
18%
Dermatologic
Grade 2
Grade
≥
3
35%
48%
100%
0%
55%
38%
52%
23%
45%
47%
60 %
11 %
Hematologic
Grade 2
Grade
≥
3
23%
61%
15%
69%
21%
59%
15%
58%
26%
40%
26 %
46 %
Genitourinary
Grade 2
Grade
≥
3
19%
3%
0%
0%
11%
0%
13%
2%
19%
0%
14 %
4 %
?