Initial Results from the Royal College of Radiologists' UK National Audit of Anal Cancer Radiotherapy 2015. Issue 3 (March 2017)

• Record Type: Journal Article
• Authors: Muirhead, R.; Drinkwater, K.; O'Cathail, S.M.; Adams, R.; Glynne-Jones, R.; Harrison, M.; Hawkins, M.A.; Sebag-Montefiore, D.; Gilbert, D.C.
• Is Part Of: Clinical oncology. Volume 29:Issue 3(2017)
• Page Start: 188
• Page End: 197
• Publication Date: 2017-03
• Subjects: Acute toxicity -- anal cancer -- audit -- IMRT; Oncology -- Periodicals; Tumors -- Periodicals; Cancer -- Treatment -- Periodicals; Radiotherapy -- Periodicals; Neoplasms -- Periodicals; Cancer -- Radiotherapy; Cancer -- Treatment; Oncology; Medical radiology; Radiotherapy; Tumors; Electronic journals; Periodicals; 616.994
• DOI: 10.1016/j.clon.2016.10.005
• Languages: English
• ISSNs: 0936-6555

Abstract

Abstract: Aims: UK guidance was recently developed for the treatment of anal cancer using intensity-modulated radiotherapy (IMRT). We audited the current use of radiotherapy in UK cancer centres for the treatment of anal cancer against such guidance. We describe the acute toxicity of IMRT in comparison with patient population in the audit treated with two-phase conformal radiotherapy and the previous published data from two-phase conformal radiotherapy, in the UK ACT2 trial. Materials and methods: A Royal College of Radiologists' prospective national audit of patients treated with radiotherapy in UK cancer centres was carried out over a 6 month period between February and July 2015. Results: Two hundred and forty-two cases were received from 40/56 cancer centres (71%). In total, 231 (95%) underwent full dose radiotherapy with prophylactic nodal irradiation. Of these, 180 (78%) received IMRT or equivalent, 52 (22%) two-phase conformal (ACT2) technique. The number of interruptions in radiotherapy treatment in the ACT2 trial was 15%. Interruptions were noted in 7% (95% confidence interval 0–14%) of courses receiving two-phase conformal and 4% (95% confidence interval 1–7%) of those receiving IMRT. The percentage of patients completing the planned radiotherapy dose, irrelevant of gaps, was 90% (95% confidence interval 82–98%) and 96% (95% confidence interval 93–99%), in two-phase conformal and IMRT respectively. The toxicity reported in the ACT2 trial, in patients receiving two-phase conformal in the audit and in patients receiving IMRT in the audit was: any toxic effect 71%, 54%, 48%, non-haematological 62%, 49%, 40% and haematological 26%, 13%, 18%, respectively. Conclusions: IMRT implementation for anal cancer is well underway in the UK with most patients receiving IMRT delivery, although its usage is not yet universal. This audit confirms that IMRT results in reduced acute toxicity and minimised treatment interruptions in comparison with previous two-phase conformal techniques. Highlights: Most UK centres deliver IMRT to all or selected anal cancer patients. IMRT reduced any grade 3 or 4 acute toxic effect in comparison with two-phase conformal from 54% to 48%. IMRT reduced interruptions in treatment in comparison with two-phase conformal from 7% to 4%. Completion rate of planned radiotherapy dose in comparison with two-phase conformal from 90% to 96%.