Efficacité et tolérance de la curiethérapie haut débit de dose en surimpression dans le carcinome épidermoïde du canal anal

Abstract : Purpose: Evaluate the efficacy and toxicity of high dose rate brachytherapy (HDR-BT) boost in anal squamous cell carcinoma (ASCC).
Material and method: Monocentric retrospective study involving patients treated by external irradiation (+/- chemotherapy), with HDR-BT boost, for a localized ASCC. Clinical evaluation was performed every six months. Oncological results are analyzed with: local relapse free-survival (LRFS), colostomy free-survival (CFS), metastatic free-survival (MFS), disease free-survival (DFS) and overall survival (OS). Acute and late toxicities were collected (CTCV4.0) and SOMA /LENT score was performed.
Results: From May 2005 to January 2018, 46 patients (pts) were analyzed. The median follow-up was 61 months (10-145 months), the median age of 65 years (34-84 years) with a sex ratio M / F = 0.24. The TNM classification was: T1 13 pts (21.7%), T2 34 pts (73.9%), T3 2 pts (4.3%), N + 6 pts (13.1%). External beam radiotherapy (EBRT) delivered a median dose of 45 Gy (36-50.4 Gy) in 25 fractions and HDR-BT 12Gy (10-18 Gy) in 3 fractions. The median overall treatment time (OTT) was 58 days (41-101 days) with a median EBRT / brachytherapy interval of 17 days (4-60 days). Oncological findings showed 5-year rates of LRFS 81.2%, MFS 88.7%, DFS 70% and OS 90%. All abdominoperineal amputations were performed in case of local relapse (4pts-8.7%) leading to a 5-year CFS of 79.5%. Acute urinary toxicities were frequent (G1: 41.3%, G2: 4.3%). The acute digestive toxicities were: G1 71.7%, G2 6.5% and G3 2.2%. The late urinary toxicities were: G1 4.3%; G2 2.2%; G3 2.2%. Late digestive toxicities were: G1 56.5%; G2 8.7%; G3 2.2% and G4 2.2%.
Conclusion: In ASCC management, HDR-BT boost appears to be a treatment with a long-term acceptable toxicity profile, shorter than EBRT boost, with a reduction of side effects.
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Master Thesis
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Émilien Bertin. Efficacité et tolérance de la curiethérapie haut débit de dose en surimpression dans le carcinome épidermoïde du canal anal. Human health and pathology. 2018. ⟨dumas-02139246⟩

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