Abstract
Background
To analyze the long-term outcomes and prognostic value of hematological parameters
in anal cancer patients receiving intensity-modulated radiation therapy (IMRT).
Materials
Hospital records of consecutive patients with anal squamous cell carcinoma who received
curative-intent IMRT according to a standardized contouring protocol between 2010
and 2020 were reviewed. Locoregional failure-free survival (LRFS), distant metastasis-free
survival (DMFS), progression-free survival (PFS), and overall survival (OS) were estimated
using the Kaplan-Meier method. Coverage of locoregional recurrences by the initial
IMRT volumes were assessed. The prognostic value of pretreatment blood counts for
PFS and OS were determined using Cox regression analysis.
Results
A total of 166 patients were analyzed with a median follow-up of 3.3 years. Forty-six
percent and 54% of patients had Stage I-II and IIIA-B cancers, respectively. The 5-year
LRFS, DMFS, PFS and OS were 81%, 89%, 65% and 76% respectively. Grade ≥ 3 toxicity
occurred in 5% of patients. Of all patients who relapsed, 70% had only locoregional
recurrence as first site of failure. Ninety percent of locoregional recurrences were
in-field. Hemoglobin, neutrophil and platelet counts were associated with PFS on univariable
analysis, but only cancer stage and p16 status remained prognostic on multivariable
analysis. Patients with more advanced cancer stages also had higher baseline neutrophil
counts. Performance status and neutrophil counts were prognostic for OS on multivariable
analysis.
Conclusion
This study affirms the long-term efficacy and safety of IMRT. Treatment resistance,
rather than radiation geographic miss, is a major issue underpinning locoregional
recurrences. Pretreatment blood counts were not validated to be independently prognostic
for disease recurrence.
Keywords
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Article info
Publication history
Published online: October 23, 2021
Accepted:
October 19,
2021
Received in revised form:
September 30,
2021
Received:
August 30,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
