Chu William, Taggar Amandeep, Ung Yee, Chan Kelvin K W, Earle Craig C, Karotki Aliaksandr, Pasetka Mark, Presutti Joe, Wong John, Zhang Liying, Wong C Shun
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Front Oncol. 2023 Jun 29;13:1183854. doi: 10.3389/fonc.2023.1183854. eCollection 2023.
HPV-associated or positive (HPV+) anal cancer patients may have better outcome compared to those with HPV negative (HPV-) disease. We report a planned interim analysis of a prospective registry study that tailors chemoradiation (CRT) for anal cancer according to HPV status.
HPV+ patients received de-escalated radiation doses of 45, 50.4 and 55.8 Gy, while HPV- received 50.4, 55.8 and 63 Gy for T1, T2 and T3/T4 disease respectively. Chemotherapy consisted of a single dose of mitomycin-C and oral capecitabine on days of RT. All patients were planned by VMAT following CT, PET/CT and MR simulation. This cohort (n = 24) had a minimum 24-month follow-up. Disease free survival (DFS) and local failure rates (LFR) were compared with 180 patients managed by standard CRT (2 cycles of mitomycin-C and 5-fluorouracil, radiation doses 50.4-63 Gy based on T-category) from 2011-2018. Propensity score comparison was performed using a retrospective to prospective 2 to 1 match based on tumor size and N-category.
In the HPV+ cohort (n = 20), there were 2 local failures. Two of 4 HPV- patients failed locally. The 30-month DFS and LFR were 79% and 17% respectively. Similar DFS and LFR were observed in the retrospective (80% and 15% respectively) and matched patients (76% and 16% respectively). No grade ≥3 neutropenia and febrile neutropenia were observed in the registry cohort whereas 19% and 14% respectively were seen in the retrospective patients.
De-escalation of CRT for HPV+ anal cancer may result in decreased acute toxicities and similar cancer outcomes compared to standard CRT.
与人类乳头瘤病毒阴性（HPV-）的肛管癌患者相比，HPV相关或阳性（HPV+）的肛管癌患者可能有更好的预后。我们报告了一项前瞻性登记研究的计划中期分析，该研究根据HPV状态为肛管癌定制放化疗（CRT）。
HPV+患者接受45、50.4和55.8 Gy的降阶梯放射剂量，而HPV-患者的T1、T2和T3/T4疾病分别接受50.4、55.8和63 Gy的放射剂量。化疗包括在放疗日给予单剂量丝裂霉素-C和口服卡培他滨。所有患者在CT、PET/CT和MR模拟后采用容积调强放疗（VMAT）进行计划。该队列（n = 24）进行了至少24个月的随访。将无病生存率（DFS）和局部失败率（LFR）与2011年至2018年接受标准CRT（2周期丝裂霉素-C和5-氟尿嘧啶，根据T分期给予50.4-63 Gy放射剂量）治疗的180例患者进行比较。基于肿瘤大小和N分期，采用回顾性到前瞻性2比1匹配进行倾向评分比较。
在HPV+队列（n = 20）中，有2例局部失败。4例HPV-患者中有2例局部失败。30个月的DFS和LFR分别为79%和17%。回顾性患者（分别为80%和15%）和匹配患者（分别为76%和16%）观察到相似的DFS和LFR。登记队列中未观察到≥3级中性粒细胞减少和发热性中性粒细胞减少，而回顾性患者中分别观察到19%和14%。
与标准CRT相比，HPV+肛管癌CRT降阶梯可能导致急性毒性降低和相似的癌症预后。
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