ESTRO 2023

Session Item

Lower GI

Session Code: 6012

Session Type: Poster (Digital)

Track: Clinical

ELDERLY ANAL CANCER PATIENTS TREATED WITH INTENSITY-MODULATED RADIATION THERAPY: A MULTICENTER STUDY

, Italy

Presentation Number: PO-1401

Abstract

Abstract Title:

ELDERLY ANAL CANCER PATIENTS TREATED WITH INTENSITY-MODULATED RADIATION THERAPY: A MULTICENTER STUDY

Authors:

Luciana Caravatta¹, Giovanna Mantello², Francesca Valvo³, Pierfrancesco Franco⁴, Lucrezia Gasparini⁵, Fiorella C. Di Guglielmo⁶, Najla Slim⁷, Stafania Manfrida⁸, Maria A. Gambacorta⁸, Francesca De Felice⁹, Marianna A. Gerardi¹⁰, Stefano Vagge¹¹, Marco Krengli¹², Elisa Palazzari¹³, Mattia Falchetto Osti¹⁴, Alessandra Gonnelli¹⁵, Gianpiero Catalano¹⁶, Patrizia Pittoni¹⁷, Giovani B. Ivaldi¹⁸, Alessandra Galardi¹⁹, Marco Lupattelli²⁰, Maria E. Rosetto²¹, Rita M. Niespolo²², Alessandra Guido²³, Oreste Durante²⁴, Gabriella Macchia²⁵, Fernando Munoz²⁶, Badr El Khouzai²⁷, Maria R. Lucido²⁸, Rolando M. D’Angelillo²⁹, Annamaria Porreca³⁰, Marta Di Nicola³⁰, Domenico Genovesi³¹

¹ "SS Annunziata" Hospital, "G. d'Annunzio" University, Radiation Oncology Unit, Chieti, Italy; ²Azienda Ospedaliero Universitaria Ospedali Riuniti, Department of Oncology and Radiotherapy, Ancona, Italy; ³CNAO National Center for Oncological Hadrontherapy, Radiotherapy Unit, Clinical Department, Pavia, Italy; ⁴University of Eastern Piedmont, Department of Oncology, Radiation Oncology, Novara, Italy; ⁵ "SS Annunziata" Hospital, "G. d'Annunzio" University, Radiation Oncology Unit, Chieti, Italy; ⁶"SS Annunziata" Hospital, "G. d'Annunzio" University, Radiation Oncology Unit, Chieti, Italy; ⁷ IRCCS San Raffaele Scientific Institute, Department of Radiotherapy, Milano, Italy; ⁸"A. Gemelli" IRCCS, Fondazione Policlinico Universitario, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy; ⁹ Policlinico Umberto I, "Sapienza" University, Department of Radiotherapy, Roma, Italy; ¹⁰IEO European Institute of Oncology, IRCCS, Department of Radiotherapy, Milano, Italy; ¹¹IRCCS Ospedale Policlinico San Martino, Department of Radiation Oncology, Genova, Italy; ¹²University of Eastern Piedmont, Division of Radiation Oncology, Department of Translational Medicine, Novara, Italy; ¹³ Oncological Referral Center, Radiation Oncology Department, Aviano, Italy; ¹⁴Sant'Andrea Hospital, Sapienza University, Unit of Radiation Oncology, Roma, Italy; ¹⁵ Azienda Ospedaliero-Universitaria Pisana, Department of Radiotherapy, Pisa, Italy; ¹⁶IRCCS Multimedica, Radiation Oncology Center, Sesto San Giovanni, Italy; ¹⁷ASST Lariana, Ospedale di Como, Radiation Oncology Unit, Como, Italy; ¹⁸ ICS Maugeri, IRCCS, Radiation Oncology Unit, Pavia, Italy; ¹⁹University Hospital, Department of Radiotherapy, Firenze, Italy; ²⁰University of Perugia and Perugia General Hospital, Radiation Oncology Section, Perugia, Italy; ²¹ Belcolle Hospital, Radiotherapy Unit, Viterbo, Italy; ²² Azienda Ospedaliera San Gerardo, Radiotherapy Unit, Monza , Italy; ²³ IRCCS Azienda Ospedaliero-Universitaria di Bologna, Radiation Oncology, Bologna , Italy; ²⁴Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Radiation Oncology , Alessandria, Italy; ²⁵Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Radiation Oncology Unit, Campobasso, Italy; ²⁶Azienda U. S. L. della Valle d'Aosta, Department of Radiotherapy, Aosta , Italy; ²⁷ Veneto Institute of Oncology-IRCCS, Radiotherapy and Nuclear Medicine Unit, Padova, Italy; ²⁸Ospedale Sanremo-ASL 1 Imperiese, Radiotherapy Unit, Sanremo, Italy; ²⁹University of Rome Tor Vergata, Department of Biomedicine and Prevention, Radiation Oncology, Roma, Italy; ³⁰"G. D'Annunzio" University of Chieti-Pescara, Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy; ³¹"G. D'Annunzio" University of Chieti-Pescara, Department of Neuroscience, Imaging and Clinical Sciences, Chieti , Italy

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Purpose or Objective

Concurrent chemo-radiotherapy (CRT) is the standard treatment for anal cancer. Intensity-modulated radiotherapy (IMRT) was proved to reduce severe acute and late toxicities. For elderly patients’ treatment needs often to be modified. Alternative treatment strategies are not described in guidelines and little evidence is available in the literature. Based on these considerations, we have analysed toxicity and treatment outcomes in patients ≥ 70 years with anal cancer treated with curative CRT.

Material and Methods

In 2020 a multi-institutional retrospective study on behalf of AIRO gastrointestinal study group was conducted to evaluate the pattern of care and clinical outcomes of anal cancer patients treated with IMRT techniques (RAINSTORM: RAdiotherapy with INtenSiTy mOdulated techniques in the treatment of anal caRcinoMa: a multicenter retrospective observation study). Currently a subgroup analyses according to the distribution of variables in age subgroups (<70 years, n=694 and ≥70 years, n= 283) was conducted. The univariate Cox proportional hazards model reports the hazard ratio (HR) and the 95% confidence interval (95% CI) for age (<70 vs. ≥70), ECOG PS (≥1 vs. 0), HIV (Yes vs. No), HPV (Yes vs. No) and baseline Haemoglobin level (Hb <10 vs. ≥ 10) as independent factors impacts on clinical outcomes: Overall Survival (OS) and Disease-Free Survival (DFS). Toxicities were retrospectively graded according to Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0.

Results

Older patients were more likely to have worse baseline performance status (PS 1 or 2) (35.3% vs. 15.7%, p <0.001), and more HIV+ status (82.7% vs. 72.9%, p <0.001), but otherwise baseline characteristics were similar. Older patients received less concomitant chemotherapy (88.0% vs. 97.4%, p <0.001) with similar compliance in terms of overall treatment times and treatment interruptions. No statistically significant increase has been reported in grade ≥3 acute and late toxicities in older patients (Table1). Stratifying by age, the probability of surviving 60 months was 85.6% (SE=1.70%) for age <70 years and 75.7% (SE=3.41%) for age ≥70 years (p=0.0001); for DFS was 78.30% (SE=1.93%) for age <70 years and 68.10% (SE=3.91%) for age ≥70 years (p= 0.0033). In patients with age ≥70 years a statistically significant association was found between HIV positive status and Hb <10 with OS and between Hb <10 and DFS.

Conclusion

In our analysis older patients who underwent CRT showed the same rates of grade ≥ 3 acute and late toxicities compared to younger patients. OS and DFS resulted significant lower in patients with age ≥70 years. Baseline haemoglobin level <10 gm/dl resulted predictive of worse OS and DFS, suggesting that a supplement supportive therapy in elderly patients may be necessary.