Anal squamous cell carcinoma: Impact of radiochemotherapy evolution over years and an explorative analysis of MRI prediction of tumor response in a mono-institutional series of 131 patients
IntroductionRadiochemotherapy (RCHT) for the treatment of anal squamous cell carcinoma (ASCC) has evolved dramatically, also thanks to intensity-modulated RT (IMRT) and 3D image guidance (3D IGRT). Despite most patients presenting fair outcomes, unmet needs still exist. Predictors of poor tumor resp...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.973223/full |
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| author | Marco Lorenzo Bonù Salvatore La Mattina Navdeep Singh Cristian Toraci Luigi Spiazzi Fabrizia Terraneo Fernando Barbera Paola Vitali Francesco Frassine Andrea Guerini Luca Triggiani Davide Tomasini Vittorio Morelli Jessica Imbrescia Jacopo Andreuccetti Barbara Frittoli Frida Pittiani Luigi Grazioli Nazario Portolani Luca Nicosia Domenico Albano Francesco Bertagna Stefano Maria Magrini Michela Buglione |
| author_facet | Marco Lorenzo Bonù Salvatore La Mattina Navdeep Singh Cristian Toraci Luigi Spiazzi Fabrizia Terraneo Fernando Barbera Paola Vitali Francesco Frassine Andrea Guerini Luca Triggiani Davide Tomasini Vittorio Morelli Jessica Imbrescia Jacopo Andreuccetti Barbara Frittoli Frida Pittiani Luigi Grazioli Nazario Portolani Luca Nicosia Domenico Albano Francesco Bertagna Stefano Maria Magrini Michela Buglione |
| author_sort | Marco Lorenzo Bonù |
| collection | DOAJ |
| description | IntroductionRadiochemotherapy (RCHT) for the treatment of anal squamous cell carcinoma (ASCC) has evolved dramatically, also thanks to intensity-modulated RT (IMRT) and 3D image guidance (3D IGRT). Despite most patients presenting fair outcomes, unmet needs still exist. Predictors of poor tumor response are lacking; acute toxicity remains challenging; and local relapse remains the main pattern of failure.Patients and methodsBetween 2010 and 2020, ASCC stages I–III treated with 3D conformal radiotherapy or IMRT and CDDP-5FU or Mytomicine-5FU CHT were identified. Image guidance accepted included 2D IGRT or 3D IGRT. The study endpoints included freedom from locoregional recurrence (FFLR), colostomy free survival (CFS), freedom from distant metastasis (FFDM), overall survival (OS), and acute and late toxicity as measured by common terminology criteria for adverse events (CTCAE) version 5.0. An exploratory analysis was performed to identify possible radiomic predictors of tumor response. Feature extraction and data analysis were performed in Python™, while other statistics were performed using SPSS® v.26.0 software (IBM®).ResultsA total of 131 patients were identified. After a median FU of 52 months, 83 patients (63.4%) were alive. A total of 35 patients (26.7%) experienced locoregional failure, while 31 patients (23.7%) relapsed with distant metastasis. Five year FFLR, CFS, DMFS and PS resulted 72.3%, 80.1%, 74.5% and 64.6%. In multivariate analysis, 2D IGRT was associated with poorer FFLR, OS, and CFS (HR 4.5, 4.1, and 5.6, respectively); 3DcRT was associated with poorer OS and CFS (HR 3.1 and 6.6, respectively). IMRT reduced severe acute gastro-intestinal (GI) and severe skin acute toxicity in comparison with 3DcRT. In the exploratory analysis, the risk of relapse depended on a combination of three parameters: Total Energy, Gray Level Size Zone Matrix’s Large Area High Gray Level Emphasis (GLSZM’s LAHGLE), and GTV volume.ConclusionsAdvances in radiotherapy have independently improved the prognosis of ASCC patients over years while decreasing acute GI and skin toxicity. IMRT and daily 3D image guidance may be considered standard of care in the management of ASCC. A combination of three pre-treatment MRI parameters such as low signal intensity (SI), high GLSZM’s LAHGLE, and GTV volume could be integrated in risk stratification to identify candidates for RT dose-escalation to be enrolled in clinical trials. |
| first_indexed | 2024-04-13T22:28:31Z |
| format | Article |
| id | doaj.art-62d094b0bb894373bf41436842ab4ae4 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-13T22:28:31Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-62d094b0bb894373bf41436842ab4ae42022-12-22T02:27:00ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-10-011210.3389/fonc.2022.973223973223Anal squamous cell carcinoma: Impact of radiochemotherapy evolution over years and an explorative analysis of MRI prediction of tumor response in a mono-institutional series of 131 patientsMarco Lorenzo Bonù0Salvatore La Mattina1Navdeep Singh2Cristian Toraci3Luigi Spiazzi4Fabrizia Terraneo5Fernando Barbera6Paola Vitali7Francesco Frassine8Andrea Guerini9Luca Triggiani10Davide Tomasini11Vittorio Morelli12Jessica Imbrescia13Jacopo Andreuccetti14Barbara Frittoli15Frida Pittiani16Luigi Grazioli17Nazario Portolani18Luca Nicosia19Domenico Albano20Francesco Bertagna21Stefano Maria Magrini22Michela Buglione23Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Medical Physics, Spedali Civili Hospital, Brescia, ItalyDepartment of Medical Physics, Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of General Surgery, Spedali Civili Hospital, Brescia, ItalyDepartment of Radiology, Spedali Civili Hospital, Brescia, ItalyDepartment of Radiology, Spedali Civili Hospital, Brescia, ItalyDepartment of Radiology, Spedali Civili Hospital, Brescia, ItalyDepartment of General Surgery, University of Brescia and Spedali Civili Hospital, Brescia, ItalyAdvanced Radiation Oncology Department, Cancer Care Centre, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, ItalyDepartment of Nuclear Medicine, ASST Spedali Civili di Brescia and Brescia University, Brescia, ItalyDepartment of Nuclear Medicine, ASST Spedali Civili di Brescia and Brescia University, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyDepartment of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, ItalyIntroductionRadiochemotherapy (RCHT) for the treatment of anal squamous cell carcinoma (ASCC) has evolved dramatically, also thanks to intensity-modulated RT (IMRT) and 3D image guidance (3D IGRT). Despite most patients presenting fair outcomes, unmet needs still exist. Predictors of poor tumor response are lacking; acute toxicity remains challenging; and local relapse remains the main pattern of failure.Patients and methodsBetween 2010 and 2020, ASCC stages I–III treated with 3D conformal radiotherapy or IMRT and CDDP-5FU or Mytomicine-5FU CHT were identified. Image guidance accepted included 2D IGRT or 3D IGRT. The study endpoints included freedom from locoregional recurrence (FFLR), colostomy free survival (CFS), freedom from distant metastasis (FFDM), overall survival (OS), and acute and late toxicity as measured by common terminology criteria for adverse events (CTCAE) version 5.0. An exploratory analysis was performed to identify possible radiomic predictors of tumor response. Feature extraction and data analysis were performed in Python™, while other statistics were performed using SPSS® v.26.0 software (IBM®).ResultsA total of 131 patients were identified. After a median FU of 52 months, 83 patients (63.4%) were alive. A total of 35 patients (26.7%) experienced locoregional failure, while 31 patients (23.7%) relapsed with distant metastasis. Five year FFLR, CFS, DMFS and PS resulted 72.3%, 80.1%, 74.5% and 64.6%. In multivariate analysis, 2D IGRT was associated with poorer FFLR, OS, and CFS (HR 4.5, 4.1, and 5.6, respectively); 3DcRT was associated with poorer OS and CFS (HR 3.1 and 6.6, respectively). IMRT reduced severe acute gastro-intestinal (GI) and severe skin acute toxicity in comparison with 3DcRT. In the exploratory analysis, the risk of relapse depended on a combination of three parameters: Total Energy, Gray Level Size Zone Matrix’s Large Area High Gray Level Emphasis (GLSZM’s LAHGLE), and GTV volume.ConclusionsAdvances in radiotherapy have independently improved the prognosis of ASCC patients over years while decreasing acute GI and skin toxicity. IMRT and daily 3D image guidance may be considered standard of care in the management of ASCC. A combination of three pre-treatment MRI parameters such as low signal intensity (SI), high GLSZM’s LAHGLE, and GTV volume could be integrated in risk stratification to identify candidates for RT dose-escalation to be enrolled in clinical trials.https://www.frontiersin.org/articles/10.3389/fonc.2022.973223/fullanal cancer (AC)radiotherapy–chemotherapyIMRT (intensity modulated radiation therapy)predictive modelingmri |
| spellingShingle | Marco Lorenzo Bonù Salvatore La Mattina Navdeep Singh Cristian Toraci Luigi Spiazzi Fabrizia Terraneo Fernando Barbera Paola Vitali Francesco Frassine Andrea Guerini Luca Triggiani Davide Tomasini Vittorio Morelli Jessica Imbrescia Jacopo Andreuccetti Barbara Frittoli Frida Pittiani Luigi Grazioli Nazario Portolani Luca Nicosia Domenico Albano Francesco Bertagna Stefano Maria Magrini Michela Buglione Anal squamous cell carcinoma: Impact of radiochemotherapy evolution over years and an explorative analysis of MRI prediction of tumor response in a mono-institutional series of 131 patients Frontiers in Oncology anal cancer (AC) radiotherapy–chemotherapy IMRT (intensity modulated radiation therapy) predictive modeling mri |
| title | Anal squamous cell carcinoma: Impact of radiochemotherapy evolution over years and an explorative analysis of MRI prediction of tumor response in a mono-institutional series of 131 patients |
| title_full | Anal squamous cell carcinoma: Impact of radiochemotherapy evolution over years and an explorative analysis of MRI prediction of tumor response in a mono-institutional series of 131 patients |
| title_fullStr | Anal squamous cell carcinoma: Impact of radiochemotherapy evolution over years and an explorative analysis of MRI prediction of tumor response in a mono-institutional series of 131 patients |
| title_full_unstemmed | Anal squamous cell carcinoma: Impact of radiochemotherapy evolution over years and an explorative analysis of MRI prediction of tumor response in a mono-institutional series of 131 patients |
| title_short | Anal squamous cell carcinoma: Impact of radiochemotherapy evolution over years and an explorative analysis of MRI prediction of tumor response in a mono-institutional series of 131 patients |
| title_sort | anal squamous cell carcinoma impact of radiochemotherapy evolution over years and an explorative analysis of mri prediction of tumor response in a mono institutional series of 131 patients |
| topic | anal cancer (AC) radiotherapy–chemotherapy IMRT (intensity modulated radiation therapy) predictive modeling mri |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.973223/full |
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