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Authors��� original file for figure 2

Authors��� original file for figure 1

Authors��� original file for figure 2

PURPOSE Radiochemotherapy is the standard treatment for anal carcinoma (ACa). Intensity-modulated radiotherapy (IMRT) has been introduced, allowing focused irradiation of the tumor area. Whether physical benefits of IMRT translate to clinical benefits has not been sufficiently demonstrated. METHODS We retrospectively reviewed data from 82 patients with newly diagnosed ACa. Patients treated with IMRT were compared with previous patients treated with conventional three-dimensional computational radiotherapy (3D-CRT). The influence of IMRT on complete remission and acute and chronic side effects was analyzed in univariate and multivariate analyses. RESULTS 39/40 patients treated with IMRT were in complete remission after 1 year compared to 31/39 patients treated with 3D-CRT (p = 0.014). Multivariate analysis confirmed tumor T stage as well as lack of IMRT treatment as risk factors for persistent tumor at 6 months. No significant benefits of IMRT were apparent at later timepoints (median follow up 52 months, IQR: 31.5-71.8 months). Patients treated with IMRT had a significantly lower degree of skin toxicity (median 2 vs. 3 in a scale ranging from 0 to 3, p = 0.00092). Rates of hematological toxicity/proctitis were not reduced and rates of acute diarrhea increased (p = 0.034). Median length of hospitalization tended to be shorter in patients treated with IMRT (n. s.). CONCLUSION We present a real-world experience of shifting radiation technique from conventional 3D-CRT to IMRT. IMRT patients had better tumor control at 1 year and lower degrees of skin toxicity. Our data indicate that IMRT can enable therapies with lower side effects with equal or better oncological results for patients with ACa.

Predictive value of symptoms for TNM-stage of anal carcinoma (similar to T- in Table 4). The final model of our multivariate logistic regression analysis had significant predictive value to distinguish early from advanced cancer (R2=0.40; p=0.040).The odds ratio of a symptom or physical finding for prediction of advanced cancer (stage III/ IV vs. stage I/ II). Only variables with p-values less than 0.10 are shown. Table S2. Characteristics of the older and younger subgroup of our anal carcinoma cohort. Statistical analysis: Mann-Whitney U test. Table S3. Characteristics of patients with involvement of the proximal (close to rectum) and distal (close to skin) anal channel. Statistical analysis: Mann Whitney U test. (PDF 233 kb)

Predictive value of symptoms for TNM-stage of anal carcinoma (similar to T- in Table 4). The final model of our multivariate logistic regression analysis had significant predictive value to distinguish early from advanced cancer (R2=0.40; p=0.040).The odds ratio of a symptom or physical finding for prediction of advanced cancer (stage III/ IV vs. stage I/ II). Only variables with p-values less than 0.10 are shown. Table S2. Characteristics of the older and younger subgroup of our anal carcinoma cohort. Statistical analysis: Mann-Whitney U test. Table S3. Characteristics of patients with involvement of the proximal (close to rectum) and distal (close to skin) anal channel. Statistical analysis: Mann Whitney U test. (PDF 233 kb)