What dose do you use for T2 anal squamous cell carcinomas measuring greater than 3cm?

Topics: Radiation Oncology • Gastrointestinal Cancers • Anal Cancer

For T2N0 anal squamous cell carcinoma, RTOG 0529 used 50.4/42Gy in 28 fractions. However, for nodal disease >3cm, 54Gy in 30 fractions is used (and similar dosing in the UK trial).

What is the rationale for treating nodes >3cm to a higher dose but not treat primaries >3cm (without nodal involvement) to the same higher dose?

If you treat primary T2 tumors greater than 3cm to 54 Gy (or some dose greater than 50.4 Gy), what dose coverage do you then use for nodes?

Answer from: Radiation Oncologist at Academic Institution

These dose questions are very difficult to answer. 50.4Gy and 54Gy are both acceptable answers to this question. Most academic centers use their own data to justify the doses that they use. To give you an example, when I started my career at MD Anderson in the 3-D era, every patient got 55Gy. When w...

Comments

Radiation Oncologist at Rush University Medical Center
As usual, @Christopher H. Crane nails it.

Answer from: Radiation Oncologist at Community Practice

I have on one occasion, for a patient with a well-lateralized 4.5 cm anal carcinoma (with a 4 cm involved contralateral internal iliac node with marked PET/CT FDG avidity and biopsy-proven) started treatment by inserting an "anal obturator" (a 10 cc syringe filled with wax) and used an IGRT-IMRT tec...

Related Questions