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Impact of the risk-adapted Nordic anal cancer group consensus guidelines on the contouring of the elective clinical target volume in anal cancer

Johnsson, Marcus ; Alkner, Sara LU ; Johnsson, Anders LU and Nilsson, Martin P. LU (2025) In Acta Oncologica 64. p.708-714
Abstract

Background and purpose: The recently published Nordic anal cancer group (NOAC) contouring guidelines aim for improved oncological outcomes and reduced toxicity in anal cancer patients treated with radiotherapy. The present work describes how the elective clinical target volume (CTVe) would change when applying the NOAC guidelines instead of the previous Australasian standard. According to the Australasian guidelines, the cranial border of the CTVe is at the common iliac bifurcation for all patients, and the external iliac region as well as the ischiorectal fossa are always included. Materials and methods: Retrospectively, 166 anal cancer patients treated with curative radiotherapy according to Australasian guidelines between 2009 and... (More)

Background and purpose: The recently published Nordic anal cancer group (NOAC) contouring guidelines aim for improved oncological outcomes and reduced toxicity in anal cancer patients treated with radiotherapy. The present work describes how the elective clinical target volume (CTVe) would change when applying the NOAC guidelines instead of the previous Australasian standard. According to the Australasian guidelines, the cranial border of the CTVe is at the common iliac bifurcation for all patients, and the external iliac region as well as the ischiorectal fossa are always included. Materials and methods: Retrospectively, 166 anal cancer patients treated with curative radiotherapy according to Australasian guidelines between 2009 and 2017 were studied in a single-center analysis. Pretherapeutic scans, and clinical information were used to categorize patients according to the NOAC guidelines for a comparison with the Australasian guidelines. Results: Applying the risk-adapted alternative of the NOAC guidelines had the external iliac region omitted in 41.0% of the patients. The cranial border was lowered from the common iliac bifurcation in 27.7% and elevated in 12.7% of the patients. Elderly patients (≥70 years) more often had the external iliac region omitted than younger patients (60.9% vs. 33.3%; p = 0.001). The entire ischiorectal fossa was included in 23.7% of the patients due to tumor extension beyond the levator ani muscles or external sphincter. Interpretation: Contouring according to the NOAC risk-adapted guidelines changed, and mainly reduced, the CTVe in about half of all patients. Prospective follow-up is needed to determine if this is clinically beneficial.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Anal carcinoma, contouring guidelines, delineation, lymph node metastasis, radiotherapy
in
Acta Oncologica
volume
64
pages
7 pages
publisher
Taylor & Francis
external identifiers
  • pmid:40420400
  • scopus:105006949882
ISSN
0284-186X
DOI
10.2340/1651-226X.2025.42723
language
English
LU publication?
yes
id
53190d62-1b55-4ca6-bc0c-9d94c85ea1d2
date added to LUP
2025-08-04 12:52:03
date last changed
2025-08-05 03:00:05
@article{53190d62-1b55-4ca6-bc0c-9d94c85ea1d2,
  abstract     = {{<p>Background and purpose: The recently published Nordic anal cancer group (NOAC) contouring guidelines aim for improved oncological outcomes and reduced toxicity in anal cancer patients treated with radiotherapy. The present work describes how the elective clinical target volume (CTVe) would change when applying the NOAC guidelines instead of the previous Australasian standard. According to the Australasian guidelines, the cranial border of the CTVe is at the common iliac bifurcation for all patients, and the external iliac region as well as the ischiorectal fossa are always included. Materials and methods: Retrospectively, 166 anal cancer patients treated with curative radiotherapy according to Australasian guidelines between 2009 and 2017 were studied in a single-center analysis. Pretherapeutic scans, and clinical information were used to categorize patients according to the NOAC guidelines for a comparison with the Australasian guidelines. Results: Applying the risk-adapted alternative of the NOAC guidelines had the external iliac region omitted in 41.0% of the patients. The cranial border was lowered from the common iliac bifurcation in 27.7% and elevated in 12.7% of the patients. Elderly patients (≥70 years) more often had the external iliac region omitted than younger patients (60.9% vs. 33.3%; p = 0.001). The entire ischiorectal fossa was included in 23.7% of the patients due to tumor extension beyond the levator ani muscles or external sphincter. Interpretation: Contouring according to the NOAC risk-adapted guidelines changed, and mainly reduced, the CTVe in about half of all patients. Prospective follow-up is needed to determine if this is clinically beneficial.</p>}},
  author       = {{Johnsson, Marcus and Alkner, Sara and Johnsson, Anders and Nilsson, Martin P.}},
  issn         = {{0284-186X}},
  keywords     = {{Anal carcinoma; contouring guidelines; delineation; lymph node metastasis; radiotherapy}},
  language     = {{eng}},
  pages        = {{708--714}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Oncologica}},
  title        = {{Impact of the risk-adapted Nordic anal cancer group consensus guidelines on the contouring of the elective clinical target volume in anal cancer}},
  url          = {{http://dx.doi.org/10.2340/1651-226X.2025.42723}},
  doi          = {{10.2340/1651-226X.2025.42723}},
  volume       = {{64}},
  year         = {{2025}},
}