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The atomCAT2 project will analyse retrospective data from anal cancer patients treated with (chemo)radiotherapy across institutions in the UK and internationally. The study aims to develop and validate outcome prediction models using baseline patient characteristics and simple treatment-related factors. It will use distributing learning methodology, which facilitates multi-centre data analysis without individual patient data leaving the local data repository. This will allow us to examine which factors predict for effect of radiotherapy on the primary cancer, and which factors predict for metastatic spread. Ultimately, this could aid in the design of better trials for anal cancer as well as improve treatment for future patients.

Additional file 1: Appendix 1. Data dictionary

Additional file 2: Appendix 2. Specification of secondary models

Additional file 1: Appendix A. Full search strategies employed in Embase and Medline to identify relevant papers between January 1st 2000 and June 30th 2020. Appendix B. Complete results from the study quality appraisal by both reviewers (ST and RS), including the assessment criteria used. Y: Yes. N: No. NR: Not reported. Appendix C. Complete overview of study characteristics, including the predictors tested in each study. NR: not reported. SCC: Squamous cell carcinoma. RT: radiotherapy. CRT: chemoradiotherapy. MMC: Mitomycin C. Appendix D. Outcome definitions given in each study, stratified into nine categories. The final stratification yielded three disease activity outcome categories and six survival outcome categories. Appendix E. All outcomes reported in each study, along with all factors tested in both univariable and multivariable analysis. Appendix F. Clinical factors identified as prognostic for worse outcomes through univariable and multivariable analysis, stratified by outcome. Where available, factor effects and parameterisation used for analysis are also included. Appendix G. Biomarkers identified as prognostic for worse outcomes through univariable and multivariable analysis, stratified by outcome. Where available, factor effects and parameterisation used for analysis are also included. Appendix H. Imaging factors identified as prognostic for worse outcomes through univariable and multivariable analysis, stratified by outcome. Where available, factor effects are also included.

Aims: \ud Preoperative (chemo)radiotherapy followed by total mesorectal excision is the current standard of care for patients with locally advanced rectal cancer. The use of intensity-modulated radiotherapy (IMRT) for rectal cancer is increasing in the UK. However, the extent of IMRT implementation and current practice was not previously known. A national survey was commissioned to investigate the landscape of IMRT use for rectal cancer and to inform the development of national rectal cancer IMRT guidance.\ud \ud Materials and methods: \ud A web-based survey was developed by the National Rectal Cancer IMRT Guidance working group in collaboration with the Royal College of Radiologists and disseminated to all UK radiotherapy centres. The survey enquired about the implementation of IMRT with a focus on the following aspects of the workflow: dose fractionation schedules and use of a boost; pre-treatment preparation and simulation; target volume/organ at risk definition; treatment planning and treatment verification. A descriptive statistical analysis was carried out.\ud \ud Results: \ud In total, 44 of 63 centres (70%) responded to the survey; 30/44 (68%) and 36/44 (82%) centres currently use IMRT to treat all patients and selected patients with rectal cancer, respectively. There was general agreement concerning several aspects of the IMRT workflow, including patient positioning, use of intravenous contrast and bladder protocols. Greater variation in practice was identified regarding rectal protocols; use of a boost to primary/nodal disease; target volume delineation; organ at risk delineation and dose constraints and treatment verification. Delineation of individual small bowel loops and daily volumetric treatment verification were considered potentially feasible by most centres.\ud \ud Conclusion: \ud This survey identified that IMRT is already used to treat rectal cancer in many UK radiotherapy centres, but there is heterogeneity between centres in its implementation and practice. These results have been a valuable aid in framing the recommendations within the new National Rectal Cancer IMRT Guidance.

Appendix 1. Radiotherapy eRAPID symptom report items. Appendix 2. Patient information sheet. Appendix 3. Patient consent form. (DOCX 50Â kb)