%0 Journal Article
%T Optimal organ-sparing intensity-modulated radiation therapy (IMRT) regimen for the treatment of locally advanced anal canal carcinoma: a comparison of conventional and IMRT plans
%A Cathy Menkarios
%A David Azria
%A Benoit Lalibert¨¦
%A Carmen Moscardo
%A Sophie Gourgou
%A Claire Lemanski
%A Jean-Bernard Dubois
%A Norbert Aill¨¨res
%A Pascal Fenoglietto
%J Radiation Oncology
%D 2007
%I BioMed Central
%R 10.1186/1748-717x-2-41
%X Five patients with T1-3 N0-1 anal cancer and five with T4 and/or N2-3 tumors were selected. Clinical tumor volume (CTV) included tumor, anal canal and inguinal, peri-rectal, and internal/external iliac nodes (plus pre-sacral nodes for T4/N2-3 tumors). Four plans were generated: (A) AP/PA with 3D conformal boost, (B) pelvic IMRT with conformal boost (C) pelvic IMRT with IMRT boost and (D) IMRT with simultaneous integrated boost (SIB). The dose for plans (A) to (C) was 45 Gy/25 followed by a 14.4 Gy/8 boost, and the total dose for plan (D) (SIB) was 59.4 Gy/33. Coverage of both PTV and the volume of OAR (small bowel, genitalia, iliac crest and femoral heads) receiving more than 10, 20, 30, and 40 Gy (V10, V20, V30, V40) were compared using non parametric statistics.Compared to plan (A), IMRT plans (B) to (D) significantly reduced the V30 and V40 of small bowel, bladder and genitalia for all patients. The V10 and V20 of iliac crests were similar for the N0-1 group but were significantly reduced with IMRT for the N2-3/T4 group (V20 for A = 50.2% compared to B = 33%, C = 32.8%, D = 34.3%). There was no statistical difference between 2-phase (arm C) and single-phase (SIB, arm D) IMRT plans.IMRT is superior to 3D conformal radiation treatment for anal carcinoma with respect to OAR sparing, including bone marrow sparing.The standard of care for the curative treatment of anal canal carcinoma has evolved over the past three decades, from abdomino-perineal resection and life-long colostomy to organ preservation therapy using combined radiation and chemotherapy. Organ preservation is now achieved in more than 70% of cases [1-7]. The downfall of this approach is significant acute toxicity in the form of moist desquamation, genitourinary and gastrointestinal effects, and hematologic compromise. In turn, this can lead to undue treatment breaks and long overall treatment times that may negatively influence outcome [8,9]. To compound the difficulty of decreasing side-effects, retros
%U http://www.ro-journal.com/content/2/1/41