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Hyperfractionated Accelerated Reirradiation for Patients With Recurrent Anal Cancer Previously Treated With Definitive Chemoradiation

Osborne, Eleanor M., MD*; Eng, Cathy, MD; Skibber, John M., MD; Rodriguez-Bigas, Miguel A., MD; Chang, George J., MD, MS; Nancy You, Yi-Qian, MD, MHSSc; Bednarski, Brian K., MD; Minsky, Bruce D., MD*; Delclos, Marc E., MD*; Koay, Eugene, MD, PhD*; Krishnan, Sunil, MD*; Crane, Christopher H., MD*; Das, Prajnan, MD, MS, MPH*

American Journal of Clinical Oncology: July 2018 - Volume 41 - Issue 7 - p 632–637
doi: 10.1097/COC.0000000000000338
Original Articles: Gastrointestinal

Objectives: Although chemoradiation is the standard of care for anal cancer, limited data exist regarding pelvic reirradiation (re-RT) for recurrent disease. We investigated toxicity and outcomes in patients who received prior pelvic radiation therapy (RT), and subsequently underwent hyperfractionated accelerated re-RT to the pelvis for recurrent anal cancer.

Materials and Methods: We reviewed records of 10 patients with recurrent anal squamous cell carcinoma who previously received pelvic RT to at least 30 Gy as a component of their chemoradiation and underwent re-RT in 1.5 Gy twice daily fractions to the pelvis, with either preoperative (N=7) or definitive (N=3) intent.

Results: The 3-year disease-free survival and 3-year overall survival rates were 40% and 60%. Four patients recurred within the reirradiated field, with a 3-year freedom from local progression rate of 56%. Of the 7 patients treated with preoperative intent, 5 proceeded to surgery, of whom 3 are alive and disease-free at a median duration of 43 months. Of the 3 patients treated definitively with no surgery, all are alive and disease-free at a median duration of 84 months. Re-RT resulted in one grade 3 acute toxicity and no grade 3 or higher late complications.

Conclusions: Hyperfractionated accelerated re-RT was well-tolerated in patients with previously irradiated anal cancer. Patients treated with either definitive re-RT or re-RT followed by surgical resection had excellent rates of overall survival and freedom from local progression.

Departments of *Radiation Oncology

Medical Oncology

Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX

C.H.C. has received honoraria from Vertex and EMD Serono Consulting. The other authors declare no conflicts of interest.

Reprints: Eleanor M. Osborne, MD, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, 6th floor, Houston, TX 77030. E-mail: emosborne@mdanderson.org.

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